Medicaidhttp://www.businessinsider.com/category/medicaid
en-usFri, 09 Dec 2016 13:43:28 -0500Fri, 09 Dec 2016 13:43:28 -0500The latest news on Medicaid from Business Insiderhttp://static3.businessinsider.com/assets/images/bilogo-250x36-wide-rev.pngBusiness Insiderhttp://www.businessinsider.com
http://www.businessinsider.com/the-opioid-crisis-could-get-worse-if-trump-repeals-obamacare-2016-12The opioid crisis could get worse if Trump repeals Obamacarehttp://www.businessinsider.com/the-opioid-crisis-could-get-worse-if-trump-repeals-obamacare-2016-12
Tue, 06 Dec 2016 23:15:00 -0500Keegan Hamilton
<p><span><img style="float:right;" src="http://static1.businessinsider.com/image/58346dd2ba6eb620008b5c48-2400/undefined" alt="opioid addiction heroin crisis" data-mce-source="John Moore/Getty Images" data-mce-caption="A drug user takes a needle before injecting himself with heroin on March 23, 2016 in New London, CT. Communities throughout New England and nationwide are struggling with the unprecidented heroin and opioid pain pill epidemic. On March 15, the U.S. Centers for Disease Control (CDC), announced guidelines for doctors to reduce the amount of opioid painkillers prescribed nationwide, in an effort to curb the epidemic. The CDC estimates that most new heroin addicts first became hooked on prescription pain medication before graduating to heroin, which is stronger and cheaper.">As one of its last acts of 2016, Congress could drop about $1 billion on America’s drug problem by approving the 21st Century Cures Act. </span></p>
<p><span>The bipartisan bill, which includes funds to help states combat opioid addiction and overdoses, is up for final approval in the Senate, and President Obama wants to </span><a href="https://www.whitehouse.gov/blog/2016/12/03/weekly-address-pass-21st-century-cures-act"><span>sign it into law</span></a><span> before he leaves office.</span></p>
<p><span>But even if the legislation is approved as expected, Obama won’t be around to decide exactly how the money is spent. </span></p>
<p><span>That responsibility falls to President-elect Donald Trump and the conservative ex-surgeon from Georgia he picked to lead the Department of Health and Human Services, Rep. Tom Price. Trump and Price have both vowed loudly and repeatedly to repeal the Affordable Care Act, widely known as Obamacare, which some experts feel would worsen an already dire crisis.</span></p>
<p><span><span>Trump hasn’t offered many specifics about how he’ll tackle the opioid epidemic and the </span><a href="https://www.cdc.gov/drugoverdose/epidemic/index.html"><span>78 fatal overdoses per day</span></a><span> that come with it. The situation is especially bad in many of his stronghold states, but he gave only </span><a href="https://www.donaldjtrump.com/press-releases/donald-j.-trump-remarks-in-portsmouth-nh"><span>one speech</span></a><span>about the issue on the campaign trail. </span></span></p>
<p><span><span>His remarks largely focused on reducing the supply of drugs — a strategy that has failed the U.S. for decades — but he also pledged to “dramatically expand access to treatment slots and end Medicaid policies that obstruct inpatient treatment.”</span></span></p>
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Heroin overdoses are taking over our children and others in the MIDWEST. Coming in from our southern border. We need strong border &amp; WALL! </p>— Donald J. Trump (@realDonaldTrump) <a href="https://twitter.com/mims/statuses/769539271678013440">August 27, 2016</a>
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<p><span>At the same time, however, Trump and Price want to repeal Obamacare which gave </span><a href="http://statenetwork.org/wp-content/uploads/2016/07/State-Network-Manatt-Medicaid-States-Most-Powerful-Tool-to-Combat-the-Opioid-Crisis-July-2016.pdf"><span>1.2 million people in 31 states</span></a><span> access to addiction treatment under its expansion of Medicaid. At least another least </span><a href="http://statenetwork.org/wp-content/uploads/2016/07/State-Network-Manatt-Medicaid-States-Most-Powerful-Tool-to-Combat-the-Opioid-Crisis-July-2016.pdf"><span>1.1 million</span></a><span> people with substance abuse disorders live in states that declined to opt-in to Obamacare’s Medicaid expansion. Obamacare also made substance abuse coverage an essential health benefit, requiring insurers to pay for the services.</span></p>
<p><span>Price, a Tea Party Republican from the Atlanta suburbs, has proposed </span><a href="https://www.congress.gov/bill/114th-congress/house-bill/3762/text"><span>a replacement to Obamacare</span></a><span>, but it </span><a href="http://www.nytimes.com/2016/11/30/opinion/tom-price-a-radical-choice-for-health-secretary.html?_r=0"><span>would not</span></a><span> require insurers to cover addiction treatment. Both he and Trump also want to give states greater control over Medicaid spending, an approach that raises concern among some public health experts.</span></p>
<p>“Health insurers have even more sway on a state level than the federal level, and the likelihood that they’ll mandate things that are beneficial to people is low,” said Leo Beletsky, an associate professor of law and health sciences at Northeastern University School of Law. “Taking mandates away and decreasing regulation will make it harder to ensure that people can get appropriate care for their substance use issues.”</p>
<p><span>Even with increased coverage since 2010, only one in five opioid addicts receive treatment, according a recent </span><a href="https://addiction.surgeongeneral.gov/"><span>landmark report</span></a><span> on addiction by the Surgeon General. The report strongly urged the expansion of medically-assisted treatment programs that use drugs like methadone and Suboxone. </span></p>
<p><span>Local health officials from 11 major cities have already </span><a href="http://health.baltimorecity.gov/news/testimony/2016-11-29-frontline-health-leaders-urge-presidential-transition-team-invest-public"><span>urged</span></a><span> the Trump administration to increase access to these treatments, and “ensure that addiction is addressed as the disease that it is.”</span></p>
<p><span><img src="http://static5.businessinsider.com/image/582b46e0691e8849528b6679-1766/rtx2pmal.jpg" alt="Obamacare" data-mce-source="Lucy Nicholson/Reuters" data-mce-caption="Arminda Murillo, 54, reads a leaflet on Obamacare at a health insurance enrollment event in Cudahy, California, U.S. March 27, 2014."></span></p>
<p><span>The current lack of access to treatment is partly the result of conservative states refusing to embrace medically-assisted therapies, even though the methods have been proven effective, because they’re sometimes viewed as swapping one addictive substance for another.</span></p>
<p><span>Price’s home state of Georgia, for instance, recently </span><a href="http://news.wabe.org/post/despite-overdose-epidemic-ga-puts-pause-opioid-programs"><span>placed a moratorium</span></a><span> on opening new substance abuse centers that use medically-assisted treatment. The move came despite the fact that overdose deaths are up 10 percent in Georgia, with more than 1,200 fatalities reported in 2014, the most recent year that data is available. The situation is worse elsewhere: Florida, which has twice the population of Georgia, has only 69 treatment centers, one fewer than its northern neighbor. Tennessee has just 14 for the entire state.</span></p>
<p><span>The federal government — specifically the Substance Abuse and Mental Health Services Administration, which Price will soon oversee — can push for the expansion of medically-assisted treatment. It’s unclear whether that will be on the agenda though, and states will have wiggle room regardless, since they are responsible for licensing clinics.</span></p>
<p><span>Price will also likely push to privatize public health as much as possible, according to Charles Bullock, an expert on Southern politics at the University of Georgia. “Whatever he comes up with in regard to opioid addiction, it’s going to have more a market-oriented approach than you’d get under the Obama administration or any other administration,” Bullock said.</span></p>
<p><span>The concern, the political science professor added, is that drug addicts are risky and expensive to cover, making insurers reluctant. With the repeal of Obamacare, insurers would be able to deny coverage for pre-existing conditions, like substance abuse, which would make finding help harder and more expensive for addicts.</span></p>
<p><img src="http://static2.businessinsider.com/image/578fefe94321f1d01a8b9a5c-2400/rtr44u9f.jpg" alt="opioid treatment" data-mce-source="REUTERS/Brian Snyder" data-mce-caption="Gail Dufault, the Transitional Healthcare Coordinator at the Barnstable County House of Corrections, checks that a dose of Vivitrol is mixed properly before administering the drug to inmate Kenneth Saglibene at the prison in Buzzards Bay, Massachusetts September 2, 2014."></p>
<p><span>“It would be much more the individual shopping in the market and seeing what’s offered, rather than a guarantee that your provider ensures you have access,” Bullock said. “It might be that treatment is available but at a price they can’t afford, particularly if their drug abuse problems are such that they’re not earning much.”</span></p>
<p><span>Even funding to alleviate the opioid crisis will be a question mark under Trump and Price. The $1 billion set aside by the impending 21st Century Cures Act is supposed to bankroll initiatives included in another bill, the </span><a href="https://www.congress.gov/bill/114th-congress/senate-bill/524/text"><span>Comprehensive Addiction and Recovery Act</span></a><span>, a sweeping response to the opioid crisis that Congress passed in July — but failed to fund. Critics of 21st Century Cures Act, such as Massachusetts Sen. Elizabeth Warren, who worries that the bill’s provision for yearly reauthorization won’t hold up in a Republican-controlled Congress.</span></p>
<p><span>“This final deal has only a tiny fig leaf of funding for NIH and for the opioid crisis,” Warren </span><a href="https://www.youtube.com/watch?v=A1s12VfvS2g&amp;feature=youtu.be"><span>said</span></a><span>. “And most of that fig leaf isn’t even real. Most of the money won’t be there, unless future Congresses pass future bills in future years to fund those dollars.”</span></p>
<p><span>While Trump has expressed support for the Comprehensive Addiction and Recovery Act, Price is a hardline deficit hawk who may seek to cut public spending and push people to the private sector to get treatment. And with no guarantee of substance abuse coverage after the expected repeal of Obamacare, experts like Beletsky are concerned for the future.</span></p>
<p><span>“Even with the Affordable Care Act, we’ve done too little to get quality prevention and quality treatment, but it’s certainly positive and there’s promising trends,” he said. “Dismantling that system and replacing it with something that’s less robust is something that will almost certainly fuel the opioid crisis.”</span></p><p><a href="http://www.businessinsider.com/the-opioid-crisis-could-get-worse-if-trump-repeals-obamacare-2016-12#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/why-boeing-747-front-hump-2016-11">Here's why Boeing 747s have a giant hump in the front</a></p> http://www.businessinsider.com/the-average-out-of-pocket-costs-for-cancer-patients-can-be-catastrophic-regardless-of-health-care-coverage-2016-11The average out-of-pocket costs for cancer patients can be catastrophic — regardless of health care coveragehttp://www.businessinsider.com/the-average-out-of-pocket-costs-for-cancer-patients-can-be-catastrophic-regardless-of-health-care-coverage-2016-11
Tue, 29 Nov 2016 23:16:00 -0500Eric Pianin
<p><img style="float:right;" src="http://static1.businessinsider.com/image/583df1ebba6eb69a018b6a19-816/551916791682a40b0732b.jpg" alt="Leukine cancer drug" data-mce-source="Flickr/Steve Depolo" data-link="https://www.flickr.com/photos/stevendepolo/5519167916/in/photolist-9pHbkw-6mTgq9-6R7yR-75Snqv-mb6wR2-73Pkgc-4rSuBr-ax26v7-avcit6-6cnxJ6-fPZth8-4oZbHy-4EmXDc-78BWgv-74azaX-gicukj-auDNKk-64DvmW-g92UsR-85VLPk-73oCXe-59v2Po-g93Bkk-78BU5V-diXTb2-78BSR4-fjKtdz-dic4xv-7LAB1W-2devL-77UVPV-9fEHiR-8ugR1f-2HtLE-LGQYQ-avW6CM-6PukZP-c61SWC-dx4iy6-9XhUao-dtePaY-dteP8Q-bHnkSp-821Gk5-5rsw4c-54FcQ-51wUoW-gjM6n9-5voxvm-6NeXQe" /></p><p></p>
<p>Many patients freely admit that that the only thing more frightening than learning that they have cancer is seeing how much it will cost to undergo treatment.</p>
<p>A new study by researchers at Johns Hopkins University found that while there is a broad range of public and private health insurance that defrays medical and drug costs, huge out-of-pocket costs can be devastating to patients and force a major change in their lives.</p>
<p>This is especially true for many elderly and disabled Americans on Medicare, who are required to pay annual out-of-pocket costs ranging from $2,116 to $8,115 &ndash; and that&rsquo;s above and beyond what they pay in premiums for health insurance, according to the new survey.</p>
<p>Cancer is by far the costliest disease to treat, according to the researchers, especially in light of breakthrough or experimental treatments such as immunotherapy. At the same time, much of the out-of-pocket costs stem from what the researchers view as excessive hospitalization for treatment.</p>
<p>Lauren Hersch Nicholas, assistant professor of health policy and management at Johns Hopkins University&rsquo;s Bloomberg School of Public Health, said in a statement accompanying the study that spending related to a new cancer diagnosis can quickly get out of hand, regardless of one&rsquo;s health care coverage.</p>
<p>&ldquo;The health shock can be followed by financial toxicity,&rdquo; she said. &ldquo;In many cases, doctors can bring you back to health, but it can be tremendously expensive and a lot of treatments are given without a discussion of the costs or the financial consequences.&rdquo;</p>
<p>The findings, published last week in the journal&nbsp;<a href="http://jamanetwork.com/journals/jamaoncology/fullarticle/2587048"><em>JAMA Oncology</em></a>, were based on data from more than 1,409 Medicare-covered cancer patients interviewed between 2002 and 2012. The sample included a broad socioeconomic and ethnic range and accounted for differences in geography and environment.</p>
<p>Medicare, the federal health plan for over 55 million Americans, covers just 80 percent of outpatient health costs and charges co-payments of $1,000 for each hospital visit. Of those interviewed for the study, just 15 percent had Medicare alone. Roughly half had a supplemental or &ldquo;Medigap&rdquo; plan or were receiving employer-provided or retiree benefits. The rest were either enrolled in Medicare HMOs or received Medicaid or benefits from the Department of Veterans Affairs.</p>
<p><img src="http://static4.businessinsider.com/image/54a5b2b9eab8ea28478b4567-2400" alt="Cancer" data-mce-source="REUTERS/Eric Gaillard" data-mce-caption="A patient receives chemotherapy treatment for breast cancer at the Antoine-Lacassagne Cancer Center in Nice July 26, 2012. " /></p>
<p>The average yearly out-of-pocket costs associated with a new diagnosis was as little as $2,116 for low-income Medicaid beneficiaries to $5,976 for those in a Medicare Advantage or HMO program, and as high as $8,115 for those with no Medigap or supplemental insurance.</p>
<p>Strikingly, patients who hadn&rsquo;t purchased supplemental insurance reported average annual out-of-pocket costs of one quarter of their entire yearly income, while one in ten patients said the costs amounted to at least 63 percent of their annual income.</p>
<p>The report offered several ideas for reining in cancer treatment costs.</p>
<p>One would be to impose a cap on annual out-of-pocket Medicare costs, similar to catastrophic coverage in private plans. But that would require congressional approval. House Speaker Paul Ryan (R-WI) and other GOP leaders are promoting ideas to revamp both Medicare and Medicaid to slow their long-term growth rate and control the debt, and Congress appears to be more interesting in cutting benefits than expanding on them.</p>
<p>Another idea would be for doctors to limit the costly hospitalization of cancer patients by performing common radiation and chemotherapy treatment outside of hospitals. The researchers found that inpatient hospitalizations accounted for between 12 and 46 percent of out-of-pocket cancer spending, depending on the type of insurance coverage.</p><p><a href="http://www.businessinsider.com/the-average-out-of-pocket-costs-for-cancer-patients-can-be-catastrophic-regardless-of-health-care-coverage-2016-11#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/why-boeing-747-front-hump-2016-11">Here's why Boeing 747s have a giant hump in the front</a></p> http://www.businessinsider.com/bernie-sanders-tom-price-trump-hhs-2016-11BERNIE: Trump's pick for health secretary proves what he said were 'just lies'http://www.businessinsider.com/bernie-sanders-tom-price-trump-hhs-2016-11
Tue, 29 Nov 2016 18:16:04 -0500Bob Bryan
<p><img style="float:right;" src="http://static5.businessinsider.com/image/583e03f1ba6eb606688b5afc-2400/undefined" alt="Bernie Sanders" data-mce-source="Joe Raedle/Getty images" /></p><p>Bernie Sanders is going after President-elect Donald Trump for his pick to lead the Department of Health and Human Services.</p>
<p>In a statement Tuesday, the former Democratic presidential candidate said Trump's selection of GOP Rep. Tom Price as the department's secretary went against the&nbsp;president-elect's campaign promises.</p>
<p>During the campaign, Trump said he would not touch various entitlement programs such as Medicare and Medicaid, which Sanders said were "<span>of life-and-death importance for millions of Americans."</span></p>
<p><span>"<span>Now, he has nominated a person for secretary of Health and Human Services, Rep. Tom Price, who has a long history of wanting to do exactly the opposite of what Trump campaigned on," Sanders said. "Rep. Price has a long history of wanting to cut Social Security, Medicare and Medicaid. What hypocrisy!"</span></span></p>
<p>Price has a history in the health sector as an orthopedic surgeon, and has proposed to <a href="http://www.businessinsider.com/tom-price-donald-trump-hhs-secretary-obamacare-2016-11">repeal the Affordable Care Act, better known as Obamacare</a>, and radically change the government-sponsored insurance programs.</p>
<p>Price has endorsed House Speaker Paul Ryan's plan&nbsp;<a href="http://www.businessinsider.com/gop-is-eyeing-medicare-overhaul-in-2017-2016-11">for a privatized</a>&nbsp;Medicare system, which would provide&nbsp;a grant to Americans to buy private health insurance instead of offering care through the government.</p>
<p>Given Trump's promises during the campaign and Price's positions, Sanders said the president-elect should&nbsp;rescind the appointment.</p>
<p>"<span>Mr. Trump needs to tell the American people that what he said during the campaign were just lies, or else appoint an HHS secretary who will protect these programs and do what Trump said he would do," he said.</span></p><p><strong>SEE ALSO:&nbsp;<a href="http://www.businessinsider.com/tom-price-donald-trump-hhs-secretary-obamacare-2016-11" >Trump's new Cabinet pick wants to destroy Obamacare</a></strong></p>
<p><a href="http://www.businessinsider.com/bernie-sanders-tom-price-trump-hhs-2016-11#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/donald-trump-morning-ritual-election-ego-president-2016-12">Donald Trump's 'strange' morning habit tells you everything you need to know about him</a></p> http://www.businessinsider.com/republicans-replace-obamacare-fix-medicaid-2016-11Here's how Republicans who want to replace Obamacare can also fix Medicaidhttp://www.businessinsider.com/republicans-replace-obamacare-fix-medicaid-2016-11
Mon, 28 Nov 2016 22:08:00 -0500Marc Joffe
<p><img style="float:right;" src="http://static6.businessinsider.com/image/583ca65be02ba72a008b6848-911/undefined" alt="donald trump" data-mce-source="Sarah Rice/Getty Images" data-mce-caption="Donald Trump at a campaign event in Maine." /></p><p></p>
<p>Any Republican attempt to replace the Affordable Care Act must address Medicaid, which has literally become the 800-pound gorilla in the health-care policy room.</p>
<p>Simply rolling back the ACA&rsquo;s Medicaid expansion would spike the number of uninsured Americans and expose Congress and the Trump administration to withering criticism.</p>
<p>On the other hand, leaving Medicaid unchanged exposes the federal budget to the program&rsquo;s unsustainable cost trajectory: Federal Medicaid spending has&nbsp;<a href="https://www.cbo.gov/sites/default/files/51134-2016-03-HistoricalBudgetData.xlsx">doubled</a>&nbsp;over the past decade.</p>
<p>While the debate over Obamacare normally focuses on the health-care exchanges, the law&rsquo;s impact on Medicaid has been even more consequential.</p>
<p>About 10.4 million individuals were&nbsp;<a href="http://healthaffairs.org/blog/2016/10/19/examining-the-hhs-projections-for-2017-marketplace-enrollment/">covered</a>&nbsp;under a health-care exchange plan in early 2016, but Medicaid enrollment&nbsp;<a href="https://aspe.hhs.gov/sites/default/files/pdf/187551/ACA2010-2016.pdf">increased</a>&nbsp;by 14.5 million between the Affordable Care Act&rsquo;s implementation and late 2015 (this and other Medicaid statistics I cite include the closely related Children&rsquo;s Health Insurance Plan).</p>
<p>By August 2016, Medicaid enrollment&nbsp;<a href="https://www.medicaid.gov/medicaid/program-information/downloads/august-2016-enrollment-report.pdf">totaled</a>&nbsp;73.1 million people &mdash; over 22 percent of the nation&rsquo;s population. Medicaid&rsquo;s recent growth is attributable both to the expansion of eligibility under Obamacare and greater enrollment among individuals who were already eligible.</p>
<p>As&nbsp;<a href="http://www.forbes.com/sites/theapothecary/2016/07/20/government-report-finds-that-obamacare-medicaid-enrollees-much-more-expensive-than-expected/#328eb8252dd0">documented</a>&nbsp;by Brian Blase of the libertarian-leaning Mercatus Center, Obamacare&rsquo;s Medicaid expansion has cost much more than expected: In 2015, the cost per expansion-eligible enrollee was $6,366, more than $2,000 above projections.</p>
<p>In fiscal year 2016, the federal government&nbsp;<a href="https://www.cbo.gov/sites/default/files/114th-congress-2015-2016/reports/52152-mbr.pdf">spent</a>&nbsp;around $368 billion on Medicaid, with states&nbsp;<a href="https://www.medicaid.gov/medicaid/financing-and-reimbursement/downloads/medicaid-actuarial-report-2015.pdf">kicking in</a>&nbsp;roughly $220 billion more.</p>
<p>While the federal government sets many program rules, it is the states that manage Medicaid on a day-to-day basis. And this creates perverse incentives. Every time a state reimburses a provider for Medicaid services, its spending is matched at least one for one by a federal grant.</p>
<p>Since states pay only a fraction of the budgetary cost of Medicaid reimbursements, they can enrich powerful health-care provider constituencies at a low budgetary cost to the state.</p>
<p><img src="http://static6.businessinsider.com/image/5827171b5124c90e359ecec4-800" alt="U.S. President Barack Obama signs the Affordable Care Act, dubbed Obamacare, the comprehensive healthcare reform legislation during a ceremony in the East Room of the White House in Washington, U.S., March 23, 2010. REUTERS/Jason Reed/File Photo" data-mce-source="Thomson Reuters" data-mce-caption="U.S. President Barack Obama signs the Affordable Care Act dubbed Obamacare the comprehensive healthcare reform legislation at the White House in Washington" /></p>
<p>This effect was on display during this election season in California. Television viewers were bombarded by advertisements for Proposition 52, a measure that extends a temporary state fee on hospitals.</p>
<p>Revenues the state collects from imposing the fee are dedicated to the state&rsquo;s Medicaid program, known as Medi-Cal. Hospitals and other health-care interests&nbsp;<a href="https://ballotpedia.org/California_Proposition_52,_Continued_Hospital_Fee_Revenue_Dedicated_to_Medi-Cal_Unless_Voters_Approve_Changes_(2016)">spent more than $60 million</a>&nbsp;in campaign contributions to get the measure approved.</p>
<p>It may seem odd that hospitals would fight so hard to have a state fee imposed upon them until one realizes that the fee is simply a device for extracting more federal money through Medicaid &mdash; money that then flows back to hospitals.</p>
<p>California is not alone in doing this;&nbsp;<a href="http://www.ncsl.org/research/health/health-provider-and-industry-state-taxes-and-fees.aspx">almost every state</a>uses these financial gimmicks. Vice President Joe Biden has&nbsp;<a href="http://www.forbes.com/sites/theapothecary/2016/02/16/biden-was-right-medicaid-provider-taxes-a-scam-that-should-be-scrapped/#4909e97c42f9">referred</a>&nbsp;to these fees as a scam that should be scrapped.</p>
<p>This perversion of state fiscal policy is usually justified as a necessary evil in pursuit of providing health care to the poor.</p>
<p>But a lot of the money is captured by hospital executives. For example, Patrick Fry, the CEO of northern California hospital group Sutter Health&nbsp;<a href="http://www.sutterhealth.org/about/financials/pdf/sutterhealth2014990form.pdf">received</a>&nbsp;$6.3 million in total compensation in 2014; Kaiser Foundation Health Plan Chairman George Halvorson&nbsp;pocketed&nbsp;$10.4 million the same year.</p>
<p>Both&nbsp;<a href="http://emma.msrb.org/ER842441-ER657716-ER1059463.pdf">Kaiser</a>&nbsp;and&nbsp;<a href="http://www.sutterhealth.org/annualreport/operations.php">Sutter</a>&nbsp;obtain hundreds of millions of dollars in Medicaid funds annually. Runaway hospital executive compensation has also become a concern for organized labor: The Service Employees International Union&nbsp;<a href="https://ballotpedia.org/California_Hospital_Executive_Compensation_Limit_Initiative_(2016)">prepared</a>&nbsp;a measure limiting pay to $450,000 annually, but was ultimately persuaded against placing it on the California ballot.</p>
<p>Much of the federal money not paid out to executives falls to the hospitals&rsquo; bottom lines. In California, overall hospital revenues&nbsp;<a href="http://oshpd.ca.gov/documents/Data/Hospital/Annual-Financial/Selected-Data/HAFD14.xlsx">exceeded</a>&nbsp;expenses by $7.9 billion during 2014. Although most hospitals are technically not-for-profit, it is still easy for stakeholders other than patients to harvest this windfall.</p>
<p>The gains can finance future executive compensation or can be plowed into sparkling new facilities, which may be unnecessary, or unnecessarily opulent, for the care provided.</p>
<p><img src="http://static1.businessinsider.com/image/57ab9b7dce38f284328b5d83-2400" alt="Paul Ryan" data-mce-source="Darren Hauck/Getty Images" data-mce-caption="Paul Ryan." /></p>
<p>Hospitals are not the only provider group enriched by the Medicaid program. Provider reimbursement data from the state&rsquo;s Department of Health Care Services (DHCS), which is&nbsp;<a href="http://www.openthebooks.com/search/?PensionCode=5655">available</a>&nbsp;online (after by being obtained through a FOIA request), show several doctors receiving over $1 million annually from the state&rsquo;s Medi-Cal program, including a couple of obstetricians who have mostly negative reviews on Yelp.</p>
<p>With most of its funds coming from the federal government, DHCS has less incentive to monitor physicians receiving these large payouts.</p>
<p>To encourage states to properly manage Medicaid spending, Congress should replace the federal matching scheme with a different funding mechanism. Earlier this year, House Republicans&nbsp;<a href="http://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf">suggested</a>&nbsp;moving to either block grants or per capita allotments.</p>
<p>A block grant is a fixed sum of money allocated to each state to support its Medicaid spending, while a per capita allotment would provide states a fixed amount of funding per Medicaid beneficiary. In either case, annual federal funding would grow at a slower rate than it does now, but states would have much more flexibility in the way they use federal Medicaid grants, enabling them to provide services in a more cost-effective manner.</p>
<p>For example, Ohio&nbsp;<a href="http://www.medicaid.ohio.gov/Portals/0/Resources/PublicNotices/HealthyOhio-1115-Waiver.pdf">would like to implement</a>&nbsp;health savings accounts for Medicaid beneficiaries, asking them to contribute a small amount (not to exceed $8.25 per month) to these accounts, so that they have &ldquo;skin in the game.&rdquo; Ohio&rsquo;s program was&nbsp;<a href="http://www.medicaid.ohio.gov/Portals/0/Resources/PublicNotices/HealthyOhio-decision09092016.pdf">rejected</a>&nbsp;by Health and Human Services but could be implemented if Congress moves to a block grant or per capita allotment framework.</p>
<p>A federal funding mechanism that eliminates perverse state incentives promises to provide better care for our less fortunate neighbors at lower taxpayer cost. While this solution may not be ideal for highly compensated hospital executives and unscrupulous physicians, it will be a win for the rest of us.</p><p><a href="http://www.businessinsider.com/republicans-replace-obamacare-fix-medicaid-2016-11#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/why-boeing-747-front-hump-2016-11">Here's why Boeing 747s have a giant hump in the front</a></p> http://www.businessinsider.com/ap-republican-states-that-expanded-medicaid-want-it-kept-2016-11Republican states that expanded Medicaid under Obamacare are fighting to keep ithttp://www.businessinsider.com/ap-republican-states-that-expanded-medicaid-want-it-kept-2016-11
Sun, 27 Nov 2016 17:16:00 -0500Bob Christie
<p><img style="float:right;" src="http://static4.businessinsider.com/image/583b5ac6e02ba75d658b54c6-2400/ap637374329481.jpg" alt="Jan Brewer" data-mce-source="AP Photo/Ross D. Franklin" data-mce-caption="Jan Brewer." /></p><p>PHOENIX (AP) &mdash; Former Arizona Gov. Jan Brewer fought her own Republican party in the state Legislature for months to push through a Medicaid expansion under the Affordable Care Act.</p>
<p>That was three years ago. Now, as an early Donald Trump supporter who has his ear, Brewer hopes one of the pillars of President Barack Obama's health care law can be saved as Trump pushes to dump much of the overhaul.</p>
<p>"I don't know how much of that, and I mean it sincerely, is going to be affected," she told The Associated Press in an interview. She said she's encouraging Trump's administration to look at Arizona's model because it is so cost-effective.</p>
<p>Brewer said the low-income population that the Medicaid expansion was designed to cover was one of the main drivers of the law, and she's not prepared to see that group go without care. Nearly 400,000 Arizonans have gained Medicaid insurance since Brewer's proposal took effect in 2014.</p>
<p>Arizona is one of 31 states that expanded Medicaid, many of them run by Democrats. Republicans have blocked expansion in the remaining 19 states.</p>
<p>Among the GOP-led states that expanded Medicaid, many officials are like Brewer, strong proponents of the program that has brought insurance to about 9 million low-income Americans who can't possibly afford to buy it themselves. Before the expansion, those people had little access to regular health care, and when they got sick, hospitals were forced to treat them without compensation.</p>
<p>States that strongly oppose Medicaid expansion, however, continue to do so.</p>
<p>Mississippi's three top Republican leaders have said consistently for years that they believe the state cannot afford expansion, as have Idaho's GOP leaders.</p>
<p>Florida Gov. Rick Scott called for a complete repeal of Obama's overhaul a week after the Nov. 8 election. Scott has been vague, however, about what should be done about the 20 million Americans who got health insurance through the overhaul, nearly half of them though Medicaid expansion his state rejected.</p>
<p>If he doesn't completely dump the program, Trump will be under pressure to allow changes to it to give states more control.</p>
<p><img src="http://static3.businessinsider.com/image/5581c25aeab8ea6e4453bd29-1030/screen shot 2015-06-17 at 24951 pm.png" alt="medicaid expansion" data-mce-source="Washington Center for Equitable Growth" data-mce-caption="Map of Medicaid expansion under Obamacare" /></p>
<p>Current Arizona Gov. Doug Ducey last year proposed a work requirement for healthy Medicaid recipients, premiums and co-pays and a five-year limit on coverage. The Obama administration approved limited co-pays but nixed the work requirement and the five-year limit. Michigan, Indiana and Iowa also have been allowed to charge premiums or fees, but broader changes requested by some states have been rejected.</p>
<p>Vice president-elect Mike Pence told Republican governors meeting in Florida on Nov. 14 that Trump would replace traditional Medicaid funding to states with block grants that "encourage innovation that better delivers health care to eligible residents," according to a statement from the Trump transition team.</p>
<p>Pence, Indiana's governor, expanded Medicaid in his state but got waivers from the Obama administration to implement plans that kick healthy people off the program for six months if they fail to pay premiums.</p>
<p>Arkansas Gov. Asa Hutchinson said he hopes Trump's election means the state will have more flexibility in how it spends Medicaid money. More than 300,000 people are enrolled in the state's hybrid Medicaid expansion, which uses federal expansion money to buy private insurance for low-income residents.</p>
<p>"This election means we're going to have an administration that wants to give more flexibility to the states," Hutchinson, a Republican, said recently. "So this is good news in our ability to get waivers to implement the reform we want in terms of work requirements, in terms of cost-sharing, in terms of other elements of reform that encourages employer-based insurance."</p>
<p>Hutchinson stopped short of saying whether he'd like some form of coverage for those on the expanded Medicaid program to continue if Trump and congressional Republicans repeal the Affordable Care Act.</p>
<p>But Ducey, Arizona's governor, said recently the discussion is "not only about repeal but replace."</p>
<p>"We want to see all of our citizens have access to affordable health care," Ducey told reporters in response to a question about the future of Medicaid expansion. "That was the objective. That's not where we are. We've got a new president and a new Congress, and a fresh start."</p>
<p>A spokesman for Republican Michigan Gov. Rick Snyder said he plans to work with the new administration to tout the successes and advantages of his state's Medicaid expansion.</p>
<p>"How we continue that success is important, and he's willing to discuss how to do that with anyone who has other ideas to consider," Ari Adler said.</p>
<p>As for Arizona's former governor, she said her state's Medicaid program is among the nation's best in terms of costs and provider choice. The program contracts with private insurers to provide care on a per-patient basis.</p>
<p>"I don't know how you could deliver that population any more services better, more cheaply, than what we've already done here," Brewer said.</p>
<p>___</p>
<p>Associated Press writers David Eggert in Lansing, Michigan, Gary Fineout in Orlando, Florida, and Andrew DeMillo in Little Rock, Arkansas contributed to this report.</p><p><a href="http://www.businessinsider.com/ap-republican-states-that-expanded-medicaid-want-it-kept-2016-11#comments">Join the conversation about this story &#187;</a></p> http://www.businessinsider.com/abuse-is-rampant-in-one-14-billion-medicaid-program-2016-11Abuse is rampant in one $14 billion Medicaid programhttp://www.businessinsider.com/abuse-is-rampant-in-one-14-billion-medicaid-program-2016-11
Wed, 09 Nov 2016 19:39:00 -0500Eric Pianin
<p><img style="float:right;" src="http://static5.businessinsider.com/image/58239bee691e888b588b5723-700/ising-rents-healthcare-costs-boost-us-consumer-prices-2016-9.jpg" alt="A nurse prepares a bag of saline at Intermountain Healthcare's Utah Valley Regional Medical Center in Provo, Utah April 1, 2014. REUTERS/George Frey " data-mce-source="Thomson Reuters" data-mce-caption="Nurse prepares a bag of saline at Intermountain Healthcare's Utah Valley Regional Medical Center in Provo" /></p><p>Last February, an Illinois woman was convicted in federal court of scamming a Medicaid program designed to care for the elderly in their own homes.</p>
<p>The woman, Ann Marie Sheppard, 55, of O&rsquo;Fallon, Illinois, billed Medicaid for $35,168 worth of services that she never provided to her clients over a nearly two-year period, <a href="https://www.justice.gov/usao-sdil/pr/ofallon-woman-sentenced-healthcare-fraud">according to</a> the U.S. Attorney for the Southern District of Illinois.</p>
<p>Sheppard spent part of that time vacationing in Costa Rica and taking a Caribbean cruise.</p>
<p>As it turns out, this sort of rip-off of the multi-billion-dollar Medicaid Personal Care Services program administered by the states is fairly common, according to a recent Department of Health and Human Services Inspector General&rsquo;s advisory <a href="https://oig.hhs.gov/reports-and-publications/portfolio/mpcs.asp">report</a>.</p>
<p>Indeed, the Inspector General&rsquo;s office investigated more than 200 cases of fraud and abuse of the program since 2012 and came up with some alarming findings. In a home care industry that operates with little government oversight, the possibilities for cutting corners or outright fraud are great.</p>
<p>For instance, more than 50 people employed by a medical assistance agency in Anchorage, Alaska, took part in a conspiracy to bilk Medicaid out of millions of dollars by filing bogus time sheets for services not provided to elderly Medicaid beneficiaries. In some cases, they claimed payment for assisting deceased patients.</p>
<p>The owner of the agency, Agnes Francisco, 56, was sentenced to three years in prison and fined $1.5 million last December while many of her employees were hit with stiff penalties as well, according to <a href="https://www.adn.com/crime-justice/article/good-faith-services-owner-gets-3-years-medicaid-fraud/2015/12/12/">media reports</a>.</p>
<p>&ldquo;With Medicaid growing rapidly and individuals increasingly receiving care in their communities rather than in institutional settings, effective administration of [personal care services] takes on heightened urgency,&rdquo; the Inspector General said in the latest report. The IG said a lack of internal controls is an important issue, and that fraud will likely continue to be a problem.</p>
<p>The report doesn&rsquo;t specifically quantify the extent of the fraud, and a spokesperson for the IG said she was unable to immediately provide an accurate figure. But it likely involves many hundreds of millions of dollars or more in a program that, according to Kaiser Health News, spent more than $14.5 billion in fiscal 2014. &nbsp;</p>
<p><img src="http://static2.businessinsider.com/image/572ff4b352bcd01b008c1ae0-2400/rtx2byop.jpg" alt="medical" data-mce-source="REUTERS/Lucy Nicholson" data-mce-caption="Sara Hinojosa, 31, has her blood pressure read at a free medical and dental health clinic in Los Angeles, California, U.S., April 27, 2016." /></p>
<p>As Baby Boomers continue to retire and attempt to remain in their homes for as long as possible, the demand for personal care assistants will grow by 26 percent or more over the coming decade, according to the <a href="http://www.bls.gov/ooh/personal-care-and-service/personal-care-aides.htm">Bureau of Labor Statistics</a>. There are currently about 1.8 million caregivers who earn a median income of $20,980 a year providing seniors with such daily tasks as bathing, cleaning and cooking. &nbsp;</p>
<p>The inspector general&rsquo;s office has repeatedly documented fraudulent activities in the program and has renewed its call for tougher standards, training and regulations of personal care assistants. A previous report by the IG released back in 2010 cited cases of fraud totaling $724 million.</p>
<p>The Obama administration for years has been wrestling with the problem of widespread Medicaid and Medicare fraud, which drains the government coffers of billions of dollars annually. But beyond the massive loss of revenue to unscrupulous health care providers, widespread fraud in the elderly home care program has also led to serious cases of negligence and abuse of the elderly.</p>
<p>The IG report documents numerous cases of seniors neglected by care givers and allowed to go hungry or lie in their own excrement. In some cases, seniors were neglected by their own children, who assumed responsibility as caretakers and billed Medicaid for their services.</p>
<p>In one case, a personal care provider in Vermont submitted bogus claims for 456 hours of service to an elderly man and then secretly split the payments with the patient&rsquo;s wife in return for access to her husband&rsquo;s prescription pain killers. An Idaho woman was hospitalized because of severe dehydration and malnourishment after her son, who had signed on as her caretaker, neglected her.</p>
<p>David Ceron, a special agent for the inspector general&rsquo;s office in Washington, told <a href="http://khn.org/news/seniors-suffer-amid-widespread-fraud-by-medicaid-caretakers/">Kaiser Health News</a> that &ldquo;it&rsquo;s fairly common&rdquo; for family members to be the ones neglecting or abusing seniors and the ones committing the fraud. KHN was the first to report on the IG&rsquo;s latest findings.</p><p><a href="http://www.businessinsider.com/abuse-is-rampant-in-one-14-billion-medicaid-program-2016-11#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/preauricular-sinus-small-hole-above-ear-2016-11">Here's why some people have a tiny hole above their ears</a></p> http://www.businessinsider.com/next-president-works-with-congress-to-fix-obamacare-2016-10Here's how the next president could work with Congress to fix Obamacarehttp://www.businessinsider.com/next-president-works-with-congress-to-fix-obamacare-2016-10
Wed, 26 Oct 2016 19:02:00 -0400J.B. Silvers
<p><img style="float:right;" src="http://static3.businessinsider.com/image/58110b2fb28a642b0f8b47ee-624/obama-to-give-his-diagnosis-for-what-ails-obamacare.jpg" alt="Arminda Murillo, 54, reads a leaflet on Obamacare at a health insurance enrollment event in Cudahy, California, U.S. March 27, 2014. REUTERS/Lucy Nicholson/File Photo" data-mce-source="Thomson Reuters" data-mce-caption="File photo of Murillo reading a leaflet on Obamacare at a health insurance enrollment event in Cudahy, California" /></p><p>As we all know by now, Donald Trump&nbsp;<a href="https://theconversation.com/could-the-candidates-truly-fix-or-nix-obamacare-six-essential-reads-67353">wants to repeal and replace</a> the Affordable Care Act while <a href="https://theconversation.com/could-the-candidates-truly-fix-or-nix-obamacare-six-essential-reads-67353">Hillary wants to fix it</a>. But what does that mean, and how would they do it?</p>
<p>The first question is what exactly do they want to repeal or fix. The ACA seems to have evolved into a great political Rorschach test somewhat devoid of real content but relying on projection of underlying beliefs.</p>
<p>For Republicans, it is evidence of governmental overreach and excess expenditures, while Dems seem to think of it as the essence of collective action and shared responsibility for those less fortunate. As such, neither informs the specific directions we might take from here.</p>
<h2>In reality, the <a href="http://www.healthline.com/health-slideshow/most-important-aspects-of-the-affordable-care-act">ACA </a>consists of four major parts:</h2>
<ol>
<li>Expansion of Medicaid for low-income working poor, with mostly federal financing.</li>
<li>Research on alternative ways to treat conditions to inform physician practice.</li>
<li>Tests of innovative ways to organize and deliver health care for better value that can be quickly implemented across the system.</li>
<li>The exchanges, for purchasing subsidized individual policies from private insurance companies.</li>
</ol>
<p>Of course, it is mainly the exchanges that get public attention and, unfortunately, much of that is misinformed. And even if the candidates were to change or eliminate the exchanges, the other three parts, which may well be the most important and lasting legacy of the legislation, would most likely stand.</p>
<h2>Medicaid madness?</h2>
<p><img src="http://static4.businessinsider.com/image/573508d791058423008c28bd-2400/ap1603301549487043.jpg" alt="obamacare" data-mce-source="Associated Press/Andrew Harnik" data-mce-caption="In this Oct. 6, 2015, file photo, the HealthCare.gov website, where people can buy health insurance, is displayed on a laptop screen in Washington." /></p>
<p>The easiest part of the ACA was thought to be the <a href="https://www.medicaid.gov/medicaid/program-information/downloads/modified-adjusted-gross-income-and-medicaid-chip.pdf">expansion of Medicaid to the working poor</a>, but it became a political battle. Medicaid expansion cuts states&rsquo; health care costs while providing coverage to millions more people.</p>
<p>The expansion required <a href="http://healthaffairs.org/blog/2016/03/21/the-economics-of-medicaid-expansion/">no expenditure of state money for the first three years</a>, only an acceptance of federal dollars. Thus, many considered expansion a done deal and a crucial part of the law. Then the U.S. Supreme Court <a href="http://www.scotusblog.com/2012/06/court-holds-that-states-have-choice-whether-to-join-medicaid-expansion/">ruled that states could refuse </a>to expand Medicaid.</p>
<p>Many &ndash; 26, to be precise &ndash; did just that in 2014, as Republican governors and lawmakers in red states voted to not accept the federal money. Some later changed their minds, but as of now, <a href="http://kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision/">19 states still have not expanded Medicaid</a>.</p>
<p>Even some<a href="http://politics.blog.ajc.com/2016/08/31/georgia-chamber-pitches-conservative-friendly-blueprint-for-medicaid-expansion/"> red state governors</a> who resisted the extra funds from the Feds to expand Medicaid coverage are reconsidering, albeit with some conditions that provide political cover. Only states&rsquo; rights advocates, for philosophical reasons, and budget hawks, who fear that the Feds will renege on their funding, are holding out for a repeal of this one.</p>
<h2>Beyond the exchanges</h2>
<p>While the double-digit premium increases have led to calls for repeal, it&rsquo;s important to look at the law more broadly and what can be done to fix it.</p>
<p>Two parts of the ACA <a href="https://www.cms.gov/apps/files/aca-savings-report-2012.pdf">may have dramatic impact </a>even though they totally avoid public scrutiny. They seek to change the way that health care is delivered at a very fundamental level. Research <a href="http://obamacarefacts.com/summary-of-provisions-patient-protection-and-affordable-care-act/">called for by the ACA</a> is being done by health care systems, insurers, and provider at every level, focusing on alternative ways to treat problems &ndash; something that most would assume we already do. Under the law, <a href="https://www.ncbi.nlm.nih.gov/books/NBK241388/">reimbursements to providers</a> is tied to their doing this.</p>
<p><img src="http://static6.businessinsider.com/image/580e7ba8362ca41d008b4624-2400/ap159460796730.jpg" alt="Medicare" data-mce-source="AP/ Mary Altaffer" data-mce-caption="Dr. Steve Auerbach, right, a pediatrician, participates in a rally in support of Medicaid funding outside the Waldorf Astoria hotel, Thursday, Oct. 18, 2012 in New York." /></p>
<p>But that&rsquo;s not really the case. For example, the <a href="http://www.fda.gov/Drugs/DevelopmentApprovalProcess/">FDA is charged with assuring that a drug</a> or device is effective (efficacious) and safe (not toxic or carcinogenic), not whether it is actually better than the alternative. So we have alternative drugs, devices, surgeries and so forth that all address a problem with little guidance as to which one actually is better.</p>
<p>The idea is that scientific findings will guide both <a href="http://obamacarefacts.com/summary-of-provisions-patient-protection-and-affordable-care-act/">physician practice and coverage decisions</a> toward better value and blunt that drive toward more marginal treatment at ever higher cost with limited outcomes.</p>
<p>The alternative approach to this kind of cost control is just to <a href="https://hbr.org/2014/11/how-not-to-cut-health-care-costs">cut payments, while allowing volume to expand</a>. It is unlikely that those who support cost control and those who do not will want to proceed down that path. It will lead to bankruptcy and ever declining marginal value &ndash; although those who stand to lose money may resist.</p>
<p>In a similar way, the Innovation Center <a href="https://www.cms.gov/apps/files/aca-savings-report-2012.pdf">called for in the ACA </a>is designed to try new organizational and payment models to see what works better and encourage adoption widely. The goal here is &ldquo;value,&rdquo; where that is defined as something that meets at least threshold quality metrics (e.g., hospital readmission rates) while meeting or beating actuarial estimates of cost.</p>
<p>The only ones who are arguing against these two little known parts of the act are those whose vested interests would be challenged. Drug companies are not wild about the additional standards of value for their products; hospitals argue the quality metrics are faulty, and physicians don&rsquo;t like being forced into new organizations that may limit their autonomy.</p>
<p>Big bets have been made on the future of health care, and these cannot be recalled easily. But there are places here that will likely be part of Hillary&rsquo;s &ldquo;fixing&rdquo; of the ACA.</p>
<h2>And then there are marketplaces</h2>
<p><img src="http://static3.businessinsider.com/image/58110bc0b28a6436008b523a-2400/rtx1mfld.jpg" alt="bernie sanders medicare for all" data-mce-source="Reuters/Gary Cameron" data-mce-caption="Democratic presidential candidate Bernie Sanders (I-VT) delivers remarks at a National Nurses United event to honor Medicare and Medicaid's 50th anniversary on Capitol Hill in Washington July 30, 2015." /></p>
<p>So that leaves us with the &ldquo;disaster&rdquo; of the individual insurance markets decried by Trump, who has said he would eliminate the marketplaces in favor of open competition across state lines. Allowing insurance companies to offer insurance in different states, the thinking goes, will increase competition of plans and lower rates for consumers.</p>
<p>Unfortunately, the companies don&rsquo;t seem interested <a href="http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2012/rwjf401409">since they already can do this to some extent</a> but don&rsquo;t. One reason is that premiums are based, in part, on <a href="http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2012/rwjf401409">negotiated rates with providers</a>. It is hard to build provider networks in another state, from another state.</p>
<p><a href="http://healthaffairs.org/blog/2013/03/06/no-competition-the-price-of-a-highly-concentrated-health-care-market/">The level of competition insurers face is secondary</a> and may be a detriment in driving provider rates lower.</p>
<p>In any event, cross-border competition hardly is a panacea for rising costs. It is, however, an unspoken attack on the insurers as a way to break their often solid capture of the regulation process which now resides at the state level. Thus, expect industry resistance to this traditional Republican proposal.</p>
<p>The problems of the individual insurance exchanges come from many directions. Besides insurance company pricing errors compounded by their natural risk avoidance, the government changed the rules midstream and limited the range of premiums insurers can charge, which forced the young to pay too much or the old too little.</p>
<p>This was compounded by a <a href="https://theconversation.com/whats-ailing-the-aca-insurers-or-congress-64151">huge failure of Congress to hold up their end of the bargain</a> in supporting the transitional support promised by the law to companies willing to take the plunge into the unknown of the exchanges, as I wrote about in The Conversation in August. When<a href="https://theconversation.com/whats-ailing-the-aca-insurers-or-congress-64151"> only 12 percent of the support </a>promised to companies with higher than expected costs was paid, the higher risk and big losses drove many out of the markets. Thus, many of the problems of the exchanges lie directly at the feet of Congress.</p>
<p><img src="http://static5.businessinsider.com/image/580e29105124c93c70d10e7a-800/oil-industry-workers-split-between-trump-and-clinton.jpg" alt="U.S. Democratic presidential candidate Hillary Clinton boards her campaign plane at the Westchester County airport in White Plains, New York, U.S., October 24, 2016. REUTERS/Carlos Barria" data-mce-source="Thomson Reuters" data-mce-caption="U.S. Democratic presidential candidate Hillary Clinton boards her campaign plane at the Westchester County airport in White Plains, New York, U.S." /></p>
<p>A Democratic Congress would rectify this as part of the fix. Hillary also<a href="http://www.forbes.com/sites/brucejapsen/2016/05/15/hillarys-medicare-buy-in-could-replace-vanishing-retiree-coverage/#52a3a52a45eb"> would allow people in the 55-64-year-old age</a> group to buy into Medicare early. This is a form of the <a href="http://www.factcheck.org/2009/12/public-option-vs-single-payer/">&ldquo;public option&rdquo;</a> that would be popular and probably would enliven the areas where there is no competition on the exchanges.</p>
<p>The irony of the Republican opposition to the use of a competitive market with subsidies to make health insurance &ldquo;affordable&rdquo; &ndash; essentially their long time alternative &ndash; might become apparent, allowing them to engage in fixing the ACA if Congress goes blue.</p>
<p>Interestingly, Clinton has a number of <a href="http://time.com/money/4327009/hillary-clinton-medicare-proposal-3-questions/">other positions </a>that one could argue would move us toward lower cost and higher quality as promised by the ACA. One of the most interesting concerns <a href="https://www.hillaryclinton.com/briefing/factsheets/2016/09/02/hillarys-plan-to-respond-to-unjustified-price-hikes-for-long-available-drugs/">drugs</a>, where she would allow Medicare to bargain for lower prices, permit importation of price-controlled prescription pharmaceuticals from other countries and limit direct-to-consumer advertising.</p>
<p>Given that this is the <a href="http://healthaffairs.org/blog/2015/08/31/rising-cost-of-drugs-where-do-we-go-from-here/">most inflationary of any sector of health care </a>and that many firms seem to have engaged in exploitative pricing, these are likely to get attention from both sides of the aisle although Republicans have said little about their approach.</p>
<p>So overall, it is unlikely that we would actually see a full &ldquo;repeal and replace&rdquo; from the GOP. There are some signs that Congress is open to fixing the ACA, as evidenced by a few Republicans, such as Rep. <a href="http://www.bloomberg.com/politics/articles/2016-08-23/clinton-win-could-pressure-gop-to-heal-not-repeal-obamacare">Dennis Ross of Florida</a>. Realistically, in their weakened position should Trump lose, compromise is more likely than in any time during the last eight years.</p>
<p>The fact that the ACA actually has <a href="http://www.usnews.com/opinion/economic-intelligence/2014/06/20/cbo-confirms-obamacare-reduces-deficits">reduced the deficit</a>, although estimates vary by how much, and <a href="http://www.forbes.com/sites/brucejapsen/2016/10/23/hillarys-right-obamacare-reduces-medicare-spending/#6484d47666ab">extended Medicare solvency</a> by many years may mean that wholesale changes would not be good. It would be important to keep those parts that have saved money. And both sides have pledged their allegiance to both of these politically popular objectives.</p>
<p>Going forward, the most likely path is the same difficult one that the U.S. system as a whole must take toward improving access and value. There will be no quick fix.</p>
<p><span><a href="https://theconversation.com/profiles/j-b-silvers-292911">J.B. Silvers</a>, Professor of Health Finance, <em><a href="http://theconversation.com/institutions/case-western-reserve-university-1506">Case Western Reserve University</a></em></span></p>
<p>This article was originally published on <a href="http://theconversation.com">The Conversation</a>. Read the <a href="https://theconversation.com/heres-how-the-next-president-could-work-with-congress-to-fix-obamacare-67529">original article</a>.</p>
<script type="text/javascript" src="https://theconversation.com/javascripts/lib/content_tracker_hook.js" id="theconversation_tracker_hook" data-counter="https://counter.theconversation.edu.au/content/67529/count?distributor=republish-lightbox-advanced" async="async"></script><p><a href="http://www.businessinsider.com/next-president-works-with-congress-to-fix-obamacare-2016-10#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/nasa-spot-massive-hole-sun-coronal-hole-video-2016-12">NASA just spotted a massive hole growing on the sun — here’s what it means</a></p> http://www.businessinsider.com/mylan-epipen-medicaid-medicare-settlement-465-million-2016-10The maker of EpiPen has agreed to pay the government $465 million after allegedly overcharging for the medicinehttp://www.businessinsider.com/mylan-epipen-medicaid-medicare-settlement-465-million-2016-10
Fri, 07 Oct 2016 16:58:09 -0400Bob Bryan
<p><img style="float:right;" src="http://static5.businessinsider.com/image/57e4155ab0ef9766008b7883-2400/ap_16265712233535.jpg" alt="Heather Bresch Mylan EpiPen" data-mce-source="AP" data-mce-caption="Mylan CEO Heather Bresch holds up an EpiPen while testifying on Capitol Hill in Washington, Wednesday, Sept. 21, 2016, before the House Oversight Committee hearing on EpiPen price increases." /></p><p>Mylan, the marker of the EpiPen, has agreed to pay the federal government a <a href="http://www.businessinsider.com/mylan-epipen-medicaid-medicare-settlement-465-million-2016-10">$465 million&nbsp;settlement</a> after it allegedly overcharged government healthcare agencies for the medicine, according to<a href="http://newsroom.mylan.com/2016-10-07-Mylan-Agrees-to-Settlement-on-Medicaid-Rebate-Classification-for-EpiPen-Auto-Injector"> a release from the firm.</a></p>
<p>Mylan had underpaid Medicare and Medicaid by classifying the EpiPen as a generic drug. Generic drugs <a href="http://www.businessinsider.com/medicaid-and-medicare-confirm-mylan-overcharged-them-2016-10">are subject to a 13% rebate</a> from the maker to Medicaid and Medicare, rather than a 23.1% rebate for brand name drugs.</p>
<p>"This agreement is another important step in Mylan's efforts to move forward and bring resolution to all EpiPen Auto-Injector related matters," said Mylan CEO Heather Bresch <a href="http://newsroom.mylan.com/2016-10-07-Mylan-Agrees-to-Settlement-on-Medicaid-Rebate-Classification-for-EpiPen-Auto-Injector">in the statement.</a></p>
<p>"Entering into this settlement is the right course of action at this time for the Company, its stakeholders and the Medicaid program."</p>
<p>The settlement comes just <a href="http://www.businessinsider.com/medicaid-and-medicare-confirm-mylan-overcharged-them-2016-10">two days after the Center for Medicare and Medicaid Services confirmed</a>&nbsp;that the company had overcharged the government health insurance program, drawing fresh cries of outrage from lawmakers. Mylan had previously come under fire for the <a href="http://www.businessinsider.com/epipen-price-increases-about-500-percent-2016-8">massive 500% price increase for&nbsp;EpiPens since 2009.</a></p>
<p>The settlement does not include any admission of wrongdoing from the company according to the release.</p>
<p>Following the news, shares of Mylan had jumped&nbsp;nearly 9.2% in after-hours trading to $39.26 per share.</p><p><strong>SEE ALSO:&nbsp;<a href="http://www.businessinsider.com/bill-clinton-obamacare-comments-trump-craziest-thing-2016-10" >Republicans are crushing Bill Clinton for calling Obamacare 'the craziest thing in the world'</a></strong></p>
<p><a href="http://www.businessinsider.com/mylan-epipen-medicaid-medicare-settlement-465-million-2016-10#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/why-boeing-747-front-hump-2016-11">Here's why Boeing 747s have a giant hump in the front</a></p> http://www.businessinsider.com/texas-is-the-worst-state-for-health-insurance-in-the-country-2016-9Texas is the worst state for health insurance in the countryhttp://www.businessinsider.com/texas-is-the-worst-state-for-health-insurance-in-the-country-2016-9
Fri, 16 Sep 2016 19:44:00 -0400Kayla Ruble
<p><img style="float:right;" src="http://static6.businessinsider.com/image/57dc14a7b0ef9748258b4da8-2400/rtr48xmb.jpg" alt="An entrance sign to the Texas Health Presbyterian Hospital is seen in Dallas, Texas, October 4, 2014." data-mce-source="Jim Young/Reuters" data-mce-caption="An entrance sign to the Texas Health Presbyterian Hospital is seen in Dallas, Texas, October 4, 2014." data-link="http://pictures.reuters.com/archive/HEALTH-EBOLA-USA-GM1EAA505GJ01.html" /></p><p>A new analysis of data from the US Census Bureau has <a href="https://www.census.gov/newsroom/releases/archives/embargoed_releases/cb16-159.html" target="_blank" data-saferedirecturl="https://www.google.com/url?hl=en-GB&amp;q=https://www.census.gov/newsroom/releases/archives/embargoed_releases/cb16-159.html&amp;source=gmail&amp;ust=1474057239758000&amp;usg=AFQjCNG3iRIXvx2vUBSOyjXXjr1-eUBfdw">revealed</a> two major reasons why Texas has the highest rate of residents without health insurance in America: The state's two largest cities, Dallas and Houston, are the least insured major metropolitan areas in the US.</p>
<p>The Census Bureau ranked the largest American cities based on the rates of uninsured residents.</p>
<p>Houston and Dallas are first and second on the list, and San Antonio &mdash; the third-largest city in Texas &mdash; comes in fourth, behind Miami.</p>
<p>The Texas health system was put under the microscope in August after multiple <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=MacDorman+MF%2C+Morton" target="_blank" data-saferedirecturl="https://www.google.com/url?hl=en-GB&amp;q=http://www.ncbi.nlm.nih.gov/pubmed/?term%3DMacDorman%2BMF%252C%2BMorton&amp;source=gmail&amp;ust=1474057239759000&amp;usg=AFQjCNFJDQ-kKR1fWmqKEMbBChzA62XYRA">reports</a>showed that its maternal mortality rate has doubled in recent years. The current rate of 30 deaths per 100,000 live births is higher than the national average of 23 per 100,000, and worse than most industrialized countries.</p>
<p>The high rates of uninsured residents are linked to Texas' failure to expand Medicaid coverage as part of the Affordable Care Act, according to Census data.</p>
<p>Since the bulk of the "Obamacare" law took effect in 2014, the rates of insured people are now higher in states that chose adopt the Medicaid expansion provision. Texas is one of 19 states that decided not to adopt that part of the bill, and it's hitting residents hard &mdash; especially in urban areas.</p>
<p>With a population of nearly 30 million people, expanding Medicaid in Texas would significantly impact insurance rates in the US. Failing to take on the policy, however, keeps millions of people in the Lone Star state living without insurance, creating a continued strain on the medical system and affecting public health.</p>
<p>People without health insurance are more likely to resort to emergency rooms for basic care, and chronic conditions like diabetes often go untreated.</p>
<p><img src="http://static6.businessinsider.com/image/57dc1503b0ef976d008b63c8-2400/rtr42han.jpg" alt="A teenager receives a tetanus vaccination at the Remote Area Medical and Operation Lone Star joint health clinic at Palmview High School in Mission, Texas August 5, 2014." data-mce-source="Shannon Stapleton/Reuters" data-mce-caption="A teenager receives a tetanus vaccination at the Remote Area Medical and Operation Lone Star joint health clinic at Palmview High School in Mission, Texas August 5, 2014." data-link="http://pictures.reuters.com/archive/USA-TEXAS-MEDICAL-GM1EA8F0FWG01.html" /></p>
<p>"The system is unsustainable," said Kristie Loescher, a healthcare policy expert at the University of Texas. "You're cutting off a vital aspect of productivity in your communities by having people who are having to deal with illness and things like that without care."</p>
<p>The low insurance rates in Texas reflect a nationwide trend. Across the country, uninsured rates are higher among lower income groups. In the case of Texas, the state's cities have the largest populations of people in poverty. Lack of health insurance is also an issue in the state's rural areas, where a shortage of healthcare providers is already a problem.</p>
<p>The insurance figures reported by individual cities tend to reflect state policies as a whole, according to Jennifer Cheeseman Day, the assistant chief of the Census Bureau's income, poverty, and health insurance division. In Texas, the main factor is medicaid.</p>
<p>In 2013, a total of 27 percent of Texans were not covered by health insurance, compared to 17 percent in 2015. Just across the border, uninsured rates in Arkansas have dropped by more than any state in the country after it expanded medicaid, from 22.5 percent in 2013 to less than 10 percent in 2015.</p>
<p><em>Follow Kayla Ruble on Twitter: <a href="https://twitter.com/RubleKB" target="_blank" data-saferedirecturl="https://www.google.com/url?hl=en-GB&amp;q=https://twitter.com/RubleKB&amp;source=gmail&amp;ust=1474057239759000&amp;usg=AFQjCNFr3xfTW-lWYGAj5YDUAMAhZGuIQw">@RubleKB</a></em></p><p><a href="http://www.businessinsider.com/texas-is-the-worst-state-for-health-insurance-in-the-country-2016-9#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/insectothopter-cia-dragonfly-spy-drone-military-defense-espionage-spies-2016-12">In the 1970s the CIA created a spy drone the size of a dragonfly</a></p> http://www.businessinsider.com/healthcare-companies-tricking-people-into-obamacare-2016-8Healthcare companies may be tricking people into Obamacare (AET)http://www.businessinsider.com/healthcare-companies-tricking-people-into-obamacare-2016-8
Fri, 19 Aug 2016 08:16:55 -0400Bob Bryan
<p><img style="float:right;" src="http://static3.businessinsider.com/image/57b6f8a0db5ce949188b7a0b-1500/rtxpbwr.jpg" alt="obama obamacare doctors" data-mce-source="Jim Young/Reuters" data-mce-caption="U.S. President Barack Obama greets doctors from across the country after making remarks on the need for health insurance reform in the Rose Garden at the White House in Washington, October 5, 2009." /></p><p>Some healthcare providers may be steering patients toward Obamacare instead of Medicare and Medicaid, according to a release from the Centers for Medicare and Medicaid Services, or CMS.</p>
<p>CMS, the government organization in charge of Medicare and Medicaid, <a href="https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-08-18-2.html">solicited public comment</a> on Thursday for instances in which healthcare providers, such as doctors and treatment centers, misled people toward policies on the public exchanges set up by the Affordable Care Act.</p>
<p>"The request for information and letters to providers focus on situations where patients may be steered away from Medicare or Medicaid benefits, which can among other concerns, result in beneficiaries experiencing a disruption in the continuity and coordination of their care as a result of changes to their network of providers," <a href="https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-08-18-2.html">a CMS release</a> said.</p>
<p>Healthcare providers typically earn more from the Obamacare plans than from Medicare and Medicaid; thus, it is more profitable to direct patients toward Obamacare plans.</p>
<p>"We are concerned about reports that some organizations may be engaging in enrollment activities that put their profit margins ahead of their patients' needs," Andy Slavitt, the acting administrator of CMS, said in <a href="https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-08-18-2.html">the release</a>.</p>
<p>One of the largest issues with the public exchanges set up by the Affordable Care Act is that <a href="http://www.businessinsider.com/obamacare-nowhere-near-dead-2016-4">healthier people have not been signing up</a> for Obamacare plans, leaving the pool of people paying into the system older and sicker. This makes the exchanges unprofitable for many insurers.</p>
<p>While the CMS solicitation does not name particular providers, it is likely that the regulator heard of such activities before asking for public comment. CMS also said it was thinking about possible enforcement action against providers undertaking the practice.</p>
<p>"<span>In particular, CMS is looking at authorities to impose civil monetary penalties on healthcare providers when their actions result in late enrollment penalties for Medicare-eligible individuals who are steered to an individual market plan and, as a result, are delayed in enrolling in Medicare," the release said.</span></p>
<p><span>This news comes in the same week that Aetna, one of the nation's largest insurers, <a href="http://www.businessinsider.com/aetna-ditching-70-of-obamacare-business-2016-8">announced that it would pull out</a> of 70% of the counties in which it offers Obamacare plans because of a $200 million loss on the exchange business in the second quarter.</span></p><p><strong>SEE ALSO:&nbsp;<a href="http://www.businessinsider.com/when-aetna-totally-abandon-obamacare-2016-8" >AETNA: Here's what it would take for us to abandon Obamacare</a></strong></p>
<p><a href="http://www.businessinsider.com/healthcare-companies-tricking-people-into-obamacare-2016-8#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/preauricular-sinus-small-hole-above-ear-2016-11">Here's why some people have a tiny hole above their ears</a></p> http://www.businessinsider.com/ohio-law-to-defund-planned-parenthood-was-overruled-by-a-federal-judge-2016-8An Ohio law meant to defund Planned Parenthood got overruledhttp://www.businessinsider.com/ohio-law-to-defund-planned-parenthood-was-overruled-by-a-federal-judge-2016-8
Fri, 12 Aug 2016 23:05:00 -0400Natasha Noman
<p><span><img src="http://static4.businessinsider.com/image/57ae4022db5ce950008b6933-2000/gettyimages-482208094.jpg" alt="Planned Parenthood" data-mce-source="Getty Images/Olivier Douliery" data-mce-caption="Anti-abortion activists hold a rally opposing federal funding for Planned Parenthood.">On Friday, a federal judge issued a </span><span data-editor-comment-id="a570caa6-f212-4dd8-99d1-5f81d4f234d2">permanent injunction</span><span> on an </span><span data-editor-comment-id="e43ac84e-c3bf-41ca-a85c-02f4508048db">Ohio law</span><span>designed to inhibit public funds from going toward Planned Parenthood, the </span><em><a href="http://abcnews.go.com/Health/wireStory/judge-blocks-ohio-law-divert-planned-parenthood-money-41331957">Associated Press</a> </em><span>reported.</span></p>
<p><span><div>
<blockquote class="twitter-tweet" lang="en">
<p>
BREAKING: Federal judge sides with Planned Parenthood, blocks Ohio law that diverts public money from group. </p>— The Associated Press (@AP) <a href="https://twitter.com/mims/statuses/764135248410058752">August 12, 2016</a>
</blockquote>
<script async src="//platform.twitter.com/widgets.js" charset="utf-8"></script>
</div></span></p>
<p>Specifically, the judge mandated the Ohio Department of Health review a Planned Parenthood grant application. </p>
<p>"That money is mostly federal and supports initiatives that provide HIV tests, cancer screenings and other prevention services," the <a href="http://abcnews.go.com/US/wireStory/judge-ohio-accept-planned-parenthood-grant-application-41331709"><em>AP</em></a> explained.</p>
<p>The law in question, set to take effect<span data-editor-comment-id="c4495e98-fb24-4459-bac5-0f604967e477"> in May</span>, sought to bar public funds from supporting organizations that offer abortion services or support.</p>
<p>In 2015, the Republican Party <a href="https://mic.com/articles/125536/abortion-rights-groups-fight-back-after-republican-vote-to-defund-planned-parenthood#.F62Y6Mkk5">launched</a> an aggressive campaign to defund and effectively dismantle the organization for its abortion services. </p>
<p>Federal funds <a href="http://www.npr.org/sections/itsallpolitics/2015/08/05/429641062/fact-check-how-does-planned-parenthood-spend-that-government-money">do not go</a> toward financing abortions — with the <a href="https://www.aclu.org/public-funding-abortion">exception</a> of certain cases under Medicaid — and Planned Parenthood <a href="https://issuu.com/actionfund/docs/annual_report_final_proof_12.16.14_/0">r<span data-editor-comment-id="5c386223-253f-4059-89fe-d1cf504d4089">eported</span></a> abortions account for only 3% of its services (though <a href="http://www.politifact.com/punditfact/statements/2015/aug/04/sandra-smith/fox-business-reporter-95-planned-parenthoods-pregn/">PolitiFact</a> estimated that figure is closer to 12%).</p><p><strong>SEE ALSO:&nbsp;<a href="http://www.businessinsider.com/donald-trump-americans-guantnamo-bay-2016-8" >Donald Trump suggests US citizens could be sent to Guantánamo Bay</a></strong></p>
<p><a href="http://www.businessinsider.com/ohio-law-to-defund-planned-parenthood-was-overruled-by-a-federal-judge-2016-8#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/preauricular-sinus-small-hole-above-ear-2016-11">Here's why some people have a tiny hole above their ears</a></p> http://www.businessinsider.com/ap-medicaid-estimate-renews-cost-concerns-over-obamacare-2016-8The cost of the Obamacare Medicare expansion is ballooninghttp://www.businessinsider.com/ap-medicaid-estimate-renews-cost-concerns-over-obamacare-2016-8
Fri, 12 Aug 2016 10:10:00 -0400Ricardo Alonso-zaldivar
<p><img style="float:right;" src="http://static3.businessinsider.com/image/57ad7afd5124c9ca20fc7563-800/ap-medicaid-estimate-renews-cost-concerns-over-obamacare.jpg" alt="FILE - In this March 23, 2010, file photo President Barack Obama is applauded after signing the Affordable Care Act into law in the East Room of the White House in Washington. Government cost estimates for expanding Medicaid to millions more low-income people are increasing faster than expected, raising questions about a vital part of President Barack Obama&rsquo;s health care law. Estimated per-person costs were an eye-catching 49 percent higher than previously calculated, according to a recent report to Congress from nonpartisan experts with the federal Centers for Medicare and Medicaid Services. The new estimate of ,366 per person for 2015 was nearly ,100 higher than expected.(AP Photo/Charles Dharapak, File)" border="0" /></p><p>WASHINGTON (AP) &mdash; The cost of expanding Medicaid to millions more low-income people is increasing faster than expected, the government says, raising questions about a vital part of President Barack Obama's health care law.</p>
<p>The law called for the federal government to pay the entire cost of the Medicaid expansion from 2014 through the end of this year.</p>
<p>Obama has proposed an extra incentive for states that have not yet expanded Medicaid: three years of full federal financing no matter when they start. But the new cost estimates could complicate things.</p>
<p>In a recent report to Congress, the Centers for Medicare and Medicaid Services said the cost of expansion was $6,366 per person for 2015, about 49 percent higher than previously estimated.</p>
<p>"We were told all along that the expansion population would be less costly," said health economist Brian Blase with the Mercatus Center at George Mason University in Virginia. "They are turning out to be far more expensive." Blase previously served as a GOP congressional aide.</p>
<p>The new estimates could be a warning light for Democrat Hillary Clinton, who has promised that if elected president she would work to expand Medicaid in the remaining 19 states that have not done so. Higher costs would make it harder for a President Clinton to sell Obama's full-financing plan to Congress.</p>
<p>Under the law, people making up to 138 percent of the federal poverty line &mdash; roughly $16,390 for an individual and $33,530 for a family of four &mdash; are eligible for Medicaid at little or no cost to them.</p>
<p>An estimated 9 million to 10 million people are covered by the Medicaid expansion, and many of the remaining uninsured are likely to be eligible if their states accept. Most of the new Medicaid recipients are low-income adults.</p>
<p>Medicaid has traditionally carried a social stigma, and conservative critics say it's no better than being uninsured. But studies have debunked that perception, showing that Medicaid eases financial burdens and provides access to needed medical attention. It can also be less complicated for the consumer than the subsidized private insurance offered by the health care law, which requires people to account to the IRS for their financial subsidies they receive.</p>
<p>The nonpartisan experts at the CMS Office of the Actuary wrote in their report that they had been expecting per-person costs to decrease in 2015. But the opposite happened: Costs went up.</p>
<p>An Obama administration spokesman says estimating the cost of a new health program is not an exact science.</p>
<p>"It is natural for estimates to change as new data become available, but the bottom line is that a growing body of evidence shows that Medicaid expansion improves the health of states' citizens, while reducing the burden of uncompensated care," CMS spokesman Aaron Albright said in a statement.</p>
<p>Albright said that the overall cost of the Affordable Care Act's coverage expansion is still lower than estimated when the law passed in 2010. However, other factors besides per-person costs enter into that overall figure. They include the total number of people enrolled, which has been lower because many states have not expanded Medicaid.</p>
<p>The report said the higher cost trend could be the result of different factors, from sicker-than-expected enrollees, to possible problems with the preliminary data that states are reporting.</p>
<p>Another significant factor is that the upfront, per-person payments states make to the private insurers who manage their Medicaid programs have been considerably higher than expected.</p>
<p>Blase sees potential for waste because Washington is still picking up the full cost of the Medicaid expansion.</p>
<p>States "have virtually no incentive to be cost-conscious," he said, and they are paying very high rates to benefit insurers and hospitals, major local businesses.</p>
<p>The government says state contracts with insurance companies usually include a mechanism for recovering overpayments. Still, it may take time to get back money that's gone into an insurer's bank account.</p>
<p>___</p>
<p>Online:</p>
<p>Medicaid report: http://tinyurl.com/ztob6z9</p><p><strong>SEE ALSO:&nbsp;<a href="http://www.businessinsider.com/aetna-re-evalutaing-obamacare-business-2016-8" >America's 3rd-largest health insurer is losing $300 million a year on Obamacare</a></strong></p>
<p><a href="http://www.businessinsider.com/ap-medicaid-estimate-renews-cost-concerns-over-obamacare-2016-8#comments">Join the conversation about this story &#187;</a></p> http://www.businessinsider.com/health-care-costs-are-pushing-debt-into-high-risk-2016-7The national debt is about to be pushed into high-risk territoryhttp://www.businessinsider.com/health-care-costs-are-pushing-debt-into-high-risk-2016-7
Fri, 15 Jul 2016 19:21:00 -0400Eric Pianin
<p><img style="float:right;" src="http://static4.businessinsider.com/image/4f29de32ecad045537000033-590/health-care-costs-money-1.gif" alt="health care costs money" data-mce-source="Flickr/401K" data-link="http://www.flickr.com/photos/68751915@N05/6793824321/sizes/z/in/photostream/" /></p><p>Last year, health care spending in the U.S. claimed 17.8 percent of the overall economy and held relatively steady.</p>
<p>But within the coming decade, health care will consume 20 percent of the overall economy, marking an important turning point for government policy makers.</p>
<p>A&nbsp;<a href="https://www.cms.gov/">new report</a>&nbsp;by the Centers on Medicare and Medicaid Services (CMS) released this week projects a 5.8 percent annual growth rate in health costs between now and 2025.</p>
<p>That is a more robust rate than we&rsquo;ve seen throughout most of the Obama administration that would exceed the overall economic growth rate by 1.3 percentage points.</p>
<p>Among the reports more salient findings:</p>
<ul>
<li>Health care spending will average in excess of $10,000 a person this year &ndash; the highest level ever --and continue to climb.</li>
<li>Medicare and Medicaid spending for seniors and low-income people will rev up in the coming decade after something of a lull.</li>
<li>Prescription drug prices will continue to increase sharply, especially the pricey specialty drugs.</li>
</ul>
<p>Moreover, the Great Recession of 2007 to 2009 served as a restraint on health care costs because many people struggling to make ends meet simply put off seeking medical assistance, prescription drugs or elective surgery. But as the economy has gradually improved, more and more Americans have purchased health insurance and sought better and more expensive medical attention.</p>
<p>&ldquo;The health sector is in the midst of a unique transition, in which various forces are exerting differential pressures on health spending growth,&rdquo; the report states. &ldquo;Economy-wide and medical-specific price growth have been very low, helping restrain inflation&rsquo;s impact on health spending, and the Medicare program is experimenting with various alternative payment approaches.&rdquo;</p>
<p>At the same time, millions of Americans have gained access to health coverage for the first time through the Affordable Care Act, with nine in ten Americans now enjoying some coverage. Obama administration officials say that the Affordable Care Act not only has extended coverage to many people but has also helped to restrain overall health spending, even though premiums and copayments have gone up in recent years.<a href="http://www.thefiscaltimes.com/2016/07/12/After-Clinton-Embraces-Sanders-Costly-Spending-He-Endorses-Her"></a><br /><br />Yet the longer-term trends outlined in the report&nbsp; suggest mounting pressure on state and federal budgets and the national debt, especially as more and more baby boomers retire and seek health care benefits. &ldquo;By 2025, as economic, legislative and demographic influences play out, the health spending share of the economy is projected to reach 20.1 percent . . . and governments are anticipated to sponsor 47 percent of health spending, up from 45 percent in 2014,&rdquo; the report states.</p>
<p>Take the Medicare program for instance. Federal spending on the premier health care program for seniors totaled roughly $647.3 billion in 2015, which was a 4.6-percent increase over the 2014 spending level.&nbsp;</p>
<p><img src="http://static3.businessinsider.com/image/5746149752bcd026008c5299-2400/rtr39nvr.jpg" alt="obamacare" data-mce-source="Reuters/Jessica Rinaldi" data-mce-caption="A Tea Party member reaches for a pamphlet titled &amp;quotThe Impact of Obamacare&amp;quot, at a &amp;quotFood for Free Minds Tea Party Rally&amp;quot in Littleton, New Hampshire Oct. 27, 2012." />By 2025, spending on Medicare will skyrocket well beyond that, with roughly one in five Americans enrolled in the program, according to the new report. Currently, about 15 percent of all Americans qualify for the program. Medicare will spend an average of about $18,000 a year for every beneficiary by 2025, compared to about $12,000 in 2015.</p>
<p>As for Medicaid, the federal and state program for lower income and disabled people, spending will average nearly $12,500 per year for enrollees in 2025, or well up from $8,000 last year.</p>
<p>The new report prepared by health care professionals at the Department of Health and Human Services is a cautionary tale about the long-term challenges to Congress and the White House of meeting the fast growing demands for health care without continuing to drive up the debt.</p>
<p>The Congressional Budget Office on Tuesday issued a warning that the national debt is running ahead of previous projections and might reach an historic 141 percent of the Gross Domestic Product by 2046.</p>
<p>Among the major factors, according to the CBO: Government spending on Social Security, Medicare and other major health care programs to serve an aging population. At the same time, CBO said, health care costs per beneficiary will rise more quickly than the overall growth in the economy.</p>
<p>Entitlement programs are expected to grow so much within the coming three decades that people over 65 years of age will account for roughly half of all federal spending other than interest on the debt, according to CBO.</p>
<p>And of course, that doesn't include additional programs that might be added in the coming years. Presumptive Democratic presidential nominee Hillary Clinton recently unveiled some new proposals to woo liberal voters, including expanding Medicare to people 55 and over and spending $40 billion more in the coming decade on community-based primary health care centers in hard to reach areas.</p><p><a href="http://www.businessinsider.com/health-care-costs-are-pushing-debt-into-high-risk-2016-7#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/preauricular-sinus-small-hole-above-ear-2016-11">Here's why some people have a tiny hole above their ears</a></p> http://www.businessinsider.com/medicaid-spending-hepatitis-drugs-2016-5Medicaid spending could skyrocket after a federal ruling on hepatitis drugshttp://www.businessinsider.com/medicaid-spending-hepatitis-drugs-2016-5
Tue, 31 May 2016 22:31:00 -0400Eric Pianin
<p><img style="float:right;" src="http://static3.businessinsider.com/image/54af09fa6bb3f7de2fc27145-2048/8266476742_9d2a40f435_k.jpg" alt="pills money drugs" data-mce-source="stockmonkeys.com" data-link="http://www.stockmonkeys.com" /></p><p>In a ruling with potentially huge adverse financial implications for state Medicaid programs across the country, a federal judge in Seattle held late last week that Washington state&rsquo;s Medicaid system must end a year-old policy allowing only patients with the most severe cases of hepatitis C infections access to new but very expensive treatments.</p>
<p>As many as three fifths of state Medicaid programs in the past year have imposed tough restrictions on millions of low-income patients and veterans seeking reimbursement for treatment of the often-deadly disease.</p>
<p>Gilead Sciences, which manufacturers the two leading biologic medications, Sovaldi and Harvoni, boasts of cure rates as high as 95 percent, compared to 40 percent for older treatments.</p>
<p>However, the drugs can cost between $83,000 and $95,000 for a full course of treatment. That has made it prohibitively expensive for Washington and other states to grant carte blanch coverage to hepatitis C patients.</p>
<p>However, U.S. District Court Judge John C. Coughenour last Friday granted a preliminary injunction forcing the state Health Care Authority to scrap a 2015 Medicaid policy that restricted access to the drugs based on a fibrosis score, which measures the extent of life-threatening liver scarring.</p>
<p>Coughenour&rsquo;s order came in response to a&nbsp;<a href="http://www.seattletimes.com/seattle-news/health/lawsuit-targets-medicaid-policy-that-limits-spendy-hep-c-drugs/">class-action lawsuit filed in February&nbsp;</a>on behalf of two clients of Washington&rsquo;s Medicaid program known as Washington Apple Health and nearly 28,000 other Medicaid enrollees suffering from various states of hepatitis C, as first reported by&nbsp;<a href="http://www.seattletimes.com/seattle-news/health/judge-orders-apple-health-to-cover-hepatitis-c-drugs-for-all/"><em>The Seattle Times</em></a>.&nbsp;</p>
<p>The two patients were a 53-year-old Seattle woman and a 47-year-old Lakewood, Washington, man who were prescribed Harvoni but were denied Medicaid coverage because of its excessive cost.</p>
<p>The federal judge ruled the state agency&rsquo;s efforts at rationing coverage of the wonder drugs were inconsistent with state and federal Medicaid requirements that drugs be made available based on medical need &ndash; and not cost.</p>
<p>It is unclear how soon the judge&rsquo;s ruling would take effect and whether the state will appeal the ruling. The judge ordered all parties to report back within 60 days.</p>
<p><img src="http://static6.businessinsider.com/image/5350b00b6da811911c1e8951-2400/ap090312034144.jpg" alt="gilead sciences" data-mce-source="AP Photo/Paul Sakuma" /></p>
<p>However, if the ruling were allowed to stand, it would have a devastating impact on Washington state&rsquo;s Medicaid prescription drug program, and would create an important precedent for similar rulings throughout the country.</p>
<p>In a letter to the U.S. Senate last fall, Washington state Medicaid director MaryAnne Lindeblad estimated that having to pay for hepatitis C treatment for all Medicaid patients seeking it would triple the agency&rsquo;s current $1 billion drug budget.</p>
<p>Thirty-three states spent more than $1 billion a year to treat the disease with Sovaldi and Harvoni, according to&nbsp;<a href="http://www.grassley.senate.gov/news/news-releases/data-behind-sovaldi-report-wyden-grassley-investigation-looks-drug-costs-every">data released</a>&nbsp;last December by Sens. Charles Grassley (R-IA) and Ron Wyden (D-OR), as&nbsp;<em>The</em>&nbsp;<em>Fiscal Times</em>&nbsp;<a href="http://www.thefiscaltimes.com/2016/02/11/Budget-Strapped-States-Are-Rationing-Hepatitis-C-Drug-Treatment">previously reported</a>.</p>
<p>Even at that remarkably high level, those funds were only enough to treat 2.4 percent of Medicaid patients who were infected with hepatitis C.</p>
<p>The federal court ruling marked an important victory for patient rights advocates &ndash; while raising the specter of astronomical new costs for other Medicaid programs, as well as the Department of Veterans Affairs, the federal prison system and other government entities that are required to provide health care coverage to millions of people.&nbsp;</p>
<p>Medicaid officials throughout the country were alarmed by the court ruling and were studying the decision&rsquo;s larger implications for their budgets.</p>
<p>Even some health care advocates were concerned about the ruling, noting that a court order lifting all restrictions on access to the costly Hepatitis-C drugs could mean sharp corresponding cutbacks in reimbursements for many other life-saving drugs.</p>
<p>&ldquo;The decision purports to guarantee everyone with Hep-C coverage for drugs that cost almost $100,000 per patient,&rdquo; John Rother, president and CEO of the National Coalition on Health Care, said in an interview on Tuesday. &ldquo;Over three million Americans carry the Hep-C virus, many with no or minor symptoms.&rdquo;</p>
<p>&ldquo;If we want to treat them all, we need to drastically lower the price of the drugs,&rdquo; he said. &ldquo;Otherwise there is simply not enough money in our healthcare budgets to pay for this. Drugs that are unaffordable are an empty promise. The court decision thus highlights the need to address increasingly unsustainable drug prices.&rdquo;</p>
<p>Rother said that a state Medicaid program needs leverage to negotiate on prices if it cannot limit utilization to those who need it most.&nbsp; &ldquo;Otherwise it is powerless to prevent price-gouging,&rdquo; he added.</p><p><a href="http://www.businessinsider.com/medicaid-spending-hepatitis-drugs-2016-5#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/income-state-top-one-percent-salary-map-2016-11">Here's how much you need to make to be in the top 1% of every state</a></p> http://www.businessinsider.com/obamacare-insurers-raked-in-15-billion-in-taxpayer-bailouts-2016-5Obamacare insurers raked in $15 billion in taxpayer 'bailouts'http://www.businessinsider.com/obamacare-insurers-raked-in-15-billion-in-taxpayer-bailouts-2016-5
Wed, 25 May 2016 18:26:00 -0400Eric Pianin
<p><img style="float:right;" src="http://static6.businessinsider.com/image/5746149752bcd026008c5299-3200-2133/rtr39nvr.jpg" alt="obamacare" data-mce-source="Reuters/Jessica Rinaldi" data-mce-caption="A Tea Party member reaches for a pamphlet titled &amp;quotThe Impact of Obamacare&amp;quot, at a &amp;quotFood for Free Minds Tea Party Rally&amp;quot in Littleton, New Hampshire Oct. 27, 2012." /></p><p>Some lawmakers are still seething over an administration decision nearly two years ago that has shortchanged the Treasury of billions of dollars by shifting the funds to an obscure Obamacare program aimed at protecting insurers against major losses.</p>
<p>The so-called Transition Reinsurance Program was designed as a three-year experiment to help guard against major premium hikes by offsetting the high cost to insurers of providing health care coverage to the least healthy Americans.</p>
<p>Essentially, it helps to &ldquo;smooth out losses&rdquo; for insurance companies operating in the Obamacare individual market.</p>
<p>But a tax imposed on all insurers in the country to fund the TRP and simultaneously bolster the U.S. Treasury has proven to be grossly inadequate. And an agency of the Department of Health and Human Services decided in 2014 to shift most of the funds to the reinsurance program without consulting Congress.</p>
<p>The diversion of billions in funds is the latest in a series of controversies around the Affordable Care Act&rsquo;s operations and funding.</p>
<p>Earlier this month, United Healthcare, the nation&rsquo;s largest health insurance company, said it was pulling out of most of the ACA exchanges where it currently operates by 2017 because of serious losses. And a multitude of financial and management problems forced nearly half of the original 23 non-profit insurance coops out of business by late last year.</p>
<p>Earlier this month, Republicans on a House Energy and Commerce subcommittee grilled HHS official Andy Slavitt concerning his agency&rsquo;s decision to divert funds away from the Treasury, which some denounced as an insurance industry &ldquo;bailout&rdquo; that comes at the expense of taxpayers.</p>
<p>Subcommittee Chairman Rep. Tim Murphy (R-PA), argued that decision was unlawful because the Affordable Care Act specifically states that the Treasury would receive funding, according to the Morning Consult.</p>
<p>&ldquo;The administration cannot rewrite its own law to make it more convenient for special interests,&rdquo; Murphy said. &ldquo;This is a dangerous&nbsp;precedent and is an affront to the separation of powers. . . Moreover, this program funnels money to insurers &mdash; now with money intended for the Treasury &mdash; in an attempt to prop up Obamacare.&rdquo;</p>
<p>A new legal opinion prepared by former GOP White House Counsel C. Boyden Gray for the conservative, free-market Galen Institute, concludes that Slavitt&rsquo;s Centers for Medicare and Medicaid Services is diverting $3.5 billion to insurance companies it was &ldquo;legally obliged to remit to the Treasury.&rdquo;</p>
<p><img src="http://static1.businessinsider.com/image/56171a199dd7cc1e008c07ac-4681-3121/ap_351825299024.jpg" alt="medicare" data-mce-source="AP Photo/Jacquelyn Martin" data-mce-caption="Nurses, from left, Katie Murphy of Boston, Kimberly Wallace of Buffalo, N.Y., and Nora Watts of Westborough, Mass., participate in a rally on Capitol Hill in Washington, Thursday, July 30, 2015." /></p>
<p>The letter &ndash; reported this week by&nbsp;<a href="http://obamacarewire.com/id/16232767183">Forbes</a>&nbsp;&ndash; said, &ldquo;By the time the books close on TRP for the 2014 and 2015 benefit years at the end of 2016,&rdquo; insurers eligible for reinsurance &ldquo;will likely have received 98 percent of expected payments&rdquo; &ndash; or $15.6 billion out of an expected $16 billion.</p>
<p>By contrast, the Treasury will likely have received only 12 percent of expected payments, or just $495 million out of an anticipated $4 billion, according to the letter.</p>
<p>TRP is one of three special programs created under the Affordable Care Act to protect the financial interests of the health insurers that ventured into a new and untested market.</p>
<p>The so-called &ldquo;risk corridor&rdquo; program was designed to limit losses or gains beyond an allowable range. Insurers that made more than the allowable gains were obliged to return part of it to the program, while companies that badly underestimated their coverage costs could dip into the fund to avert losses.</p>
<p>But Sen. Marco Rubio of Florida and other congressional Republicans criticized the risk corridors as another industry bailout and forced sharp cuts in the program&rsquo;s funding over the past two years. Last October, the administration had no choice but to provide 12.6 percent of the $2.87 billion that insurers were seeking to offset losses.</p>
<p>The controversy over the TRP is different because it relates to efforts to hold down premiums and it involves revenues raised by taxing the entire health care industry, not just those insurers taking part in Obamacare.</p>
<p>Slavitt, the acting director of the Centers for Medicare and Medicaid Services, defended his agency&rsquo;s decision to divert Treasury funds to the TRP during his appearance before the House subcommittee this month.</p>
<p>Slavitt, who was not at CMS when the decision was made, told lawmakers that it is common for federal agencies to update regulations as officials learn more, according to Morning Consult.&nbsp; While insisting that the agency did indeed have the legal authority, he conceded that the statute was unclear as to what officials should do if the reinsurance pool wasn&rsquo;t as large as expected.</p>
<p>Joseph Antos, a health care expert with the American Enterprise Institute, said on Tuesday that the controversy highlights the &ldquo;porousness&rdquo; of the Obamacare reinsurance provision. &ldquo;If the administration gets away with this, the process will become hollow.&rdquo;</p>
<p>&ldquo;The number was written into law, so it shouldn&rsquo;t have been confusing at all, and the policy action wasn&rsquo;t taken,&rdquo; he said in an interview. &ldquo;In other words, the money never got to the Treasury.&rdquo;</p>
<p>He said that Gray&rsquo;s analysis was essentially right, but that he doubted the controversy would be resolved this year, before the election.&nbsp;</p><p><a href="http://www.businessinsider.com/obamacare-insurers-raked-in-15-billion-in-taxpayer-bailouts-2016-5#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/preauricular-sinus-small-hole-above-ear-2016-11">Here's why some people have a tiny hole above their ears</a></p> http://www.businessinsider.com/ap-new-analysis-obamacare-coverage-costs-rising-2016-3Obamacare is about to get $136 billion more expensive than anticipatedhttp://www.businessinsider.com/ap-new-analysis-obamacare-coverage-costs-rising-2016-3
Thu, 24 Mar 2016 17:25:00 -0400Andrew Taylor and Ricardo Alonso-zaldivar
<p><img style="float:right;" src="http://static2.businessinsider.com/image/568c4873c08a80431d8b4981-711-533/senate-passes-symbolic-obamacare-repeal-assuring-veto.jpg" alt="Demonstrators in favor of Obamacare gather at the Supreme Court building in Washington March 4, 2015. REUTERS/Jonathan Ernst" data-mce-source="Thomson Reuters" data-mce-caption="Demonstrators in favor of Obamacare gather at the Supreme Court building in Washington" /></p><p>Expanded health insurance coverage under the Affordable Care Act, President Barack Obama's signature legislative legacy, will cost the government more, according to an official study released Thursday.</p>
<p>Still, on balance, the measure more than pays for itself.</p>
<p>The nonpartisan Congressional Budget Office said the health care law will cost $1.34 trillion over the coming decade, $136 billion more than the CBO predicted a year ago.</p>
<p>That 11 percent hike is mostly caused by higher-than-expected enrollment in the expanded Medicaid program established under the law.</p>
<p>All told, 22 million more people will have health care coverage this year than if the law had never been enacted, CBO said. The measure's coverage provisions are expected to cost $110 billion this year.</p>
<p>The number of uninsured people this year is anticipated at 27 million.</p>
<p>About 90 percent of the U.S. population will have coverage, a percentage that is expected to remain stable into the future.</p>
<p>The study also projected a slight decline in employment-based coverage, although it will remain by far the most common kind among working-age people and their families.</p>
<p>Employers now cover some 155 million people, about 57 percent of those under 65. That's expected to decline to 152 million people in 2019. Ten years from now, employers will be covering about 54 percent of those under 65.</p>
<p>CBO said part of the shrinkage is attributable to the health care law: some workers may qualify for Medicaid, which is virtually free to them, and certain employers may decide not to offer coverage because a government-subsidized alternative is available. (Larger employers would face fines if they take that route.)</p>
<p><img class="center" src="http://static3.businessinsider.com/image/568ec05d5afbd3844b8b456f-800-498/us-says-113-million-americans-have-signed-up-for-2016-obamacare-plans.jpg" alt="Kay Campos, 56, who has no health insurance and diabetes, browses leaflets at a Covered California event which marks the opening of the state's Affordable Healthcare Act, commonly known as Obamacare, health insurance marketplace in Los Angeles, California, October 1, 2013. REUTERS/Lucy Nicholson" data-mce-source="Thomson Reuters" data-mce-caption="Campos, who has no health insurance and diabetes, browses leaflets at a Covered California event in Los Angeles" />But the agency also noted that employer coverage had been declining due to rising medical costs well before the health care law was passed, and that trend continues.</p>
<p>The analysis underscores the view that the health care law is driving the nation's gains in insurance coverage, which raises political risks for Republicans who would repeal it.</p>
<p>Taking seniors covered by Medicare out of the equation, the government devotes $660 billion to subsidizing health care for people under 65, including the Medicaid program for the poor and disabled and tax benefits for employer-provided health insurance.</p>
<p>The budget office did not provide a new estimate of Obamacare's overall impact on the federal deficit, other than to say that it is, on net, expected to reduce the deficit. The law included a roster of tax increases and cuts in Medicare payments to hospitals and other providers to pay for coverage expansion.</p>
<p><img class="center" src="http://static2.businessinsider.com/image/55f8c3d9bd86ef1e008ba951-3291-2468/rtr3ixix-1.jpg" alt="obamacare" data-mce-source="Reuters/Lucy Nicholson" data-mce-caption="Arminda Murillo, 54, reads a leaflet at a health insurance enrollment event in Cudahy, California." data-link="http://pictures.reuters.com/C.aspx?VP3=SearchResult&amp;VBID=2C0BXZ06P4DUO&amp;SMLS=1&amp;RW=1199&amp;RH=843#/SearchResult&amp;VBID=2C0BXZ06P4DUO&amp;SMLS=1&amp;RW=1199&amp;RH=843&amp;PN=3&amp;POPUPPN=153&amp;POPUPIID=2C0408TVTZRXF" />The Obama administration said the report shows that the law is working to cover the uninsured and that the cost projections, when viewed in context, remain positive.</p>
<p>"It's important to appreciate that the (health care law) is not just about some race to meet a given number of enrollees," spokesman Aaron Albright said in a statement. "It is about health care in America for all of us as we go through life ... affordable insurance is not out of reach because of costs or a pre-existing condition."</p>
<p>CBO is a congressional agency that does budget forecasts and cost estimates of legislation.</p><p><a href="http://www.businessinsider.com/ap-new-analysis-obamacare-coverage-costs-rising-2016-3#comments">Join the conversation about this story &#187;</a></p> http://www.businessinsider.com/bernie-sanders-health-plan-might-be-bad-for-the-poor-2016-2Study: Bernie Sanders' health plan is actually kind of a trainwreck for the poorhttp://www.businessinsider.com/bernie-sanders-health-plan-might-be-bad-for-the-poor-2016-2
Thu, 25 Feb 2016 08:25:47 -0500Max Ehrenfreund
<p><img style="float:right;" src="http://static4.businessinsider.com/image/56c0e07e6e97c627008b733e-731-548/young-blacks-more-open-to-bernie-sanders-white-house-bid.jpg" alt="Democratic U.S. presidential candidate Senator Bernie Sanders speaks at the PBS NewsHour Democratic presidential candidates debate in Milwaukee, Wisconsin, February 11, 2016. REUTERS/Jim Young" data-mce-source="Thomson Reuters" data-mce-caption="Democratic U.S. presidential candidate Senator Bernie Sanders speaks at the PBS NewsHour Democratic presidential candidates debate in Milwaukee" /></p><p>Millions of families among the working poor and lower-middle class would be substantially worse off under the healthcare plan proposed by Bernie Sanders, according to an analysis by a public-health researcher at Atlanta's Emory University.</p>
<p>At a press conference in Columbia, South Carolina, on Wednesday, Sanders told reporters that his single-payer plan &mdash; in which the federal government, rather than the private insurance industry, would reimburse doctors and hospitals for treatment &mdash; would take "a huge bite" out of poor families' financial distress.</p>
<p>Sanders estimates that a middle-class family of four would pay an annual premium of $466 under his plan, with no deductible or co-pays. Less affluent households would pay less than that, or nothing at all.</p>
<p>But for at least 72% of households enrolled in Medicaid &mdash; in which someone is working &mdash; the costs of Sanders' plan would exceed the benefits, according to an analysis by Kenneth Thorpe, a public-health expert at Emory University.</p>
<p>That figure includes 5.7 million households, or 14.5 million people &mdash; among them, 4.2 million Hispanic recipients and 2.5 million black recipients. The requirements for eligibility for Medicaid vary widely by state, so that group includes some households living in poverty as well as some that are modestly better off.</p>
<p>"The vast majority of low-income Medicaid workers, who are probably predominantly minority, are going to end up paying more in terms of payroll taxes, and aren't going to receive really any financial benefits," said Thorpe, a former Clinton administration health official.</p>
<p><img src="http://static1.businessinsider.com/image/56171a199dd7cc1e008c07ac-4681-3121/ap_351825299024.jpg" alt="medicare" data-mce-source="AP Photo/Jacquelyn Martin" data-mce-caption="Nurses, from left, Katie Murphy of Boston, Kimberly Wallace of Buffalo, N.Y., and Nora Watts of Westborough, Mass., participate in a rally on Capitol Hill in Washington, Thursday, July 30, 2015." /></p>
<p>Many lower-income people are already insured or eligible for insurance under Medicaid, at least in the states that expanded the program under President Obama's healthcare reform. Many Medicaid beneficiaries also work, and those workers' wages would most likely decline because of the additional 6.2% payroll tax the proposal would levy on their employers.</p>
<p>Thorpe has also argued that the senator from Vermont is underestimating the cost of his plan by roughly $1.1 trillion a year. Regardless of the cost, though, the plan would be detrimental for many poor households, he concluded.</p>
<p>In calculating that 14.5 million Medicaid beneficiaries would be worse off, Thorpe used the campaign's more optimistic estimate of the cost. Using his own, more pessimistic estimate, the figure increased to 16.8 million.</p>
<p>In an email to Wonkblog, Sanders' policy director, Warren Gunnels, said the candidate's plan would have other benefits for Medicaid recipients.</p>
<p>Research has found that some specialists refuse patients on Medicaid. Gunnels suggested that Sanders' plan would solve that kind of problem. For example, in a single-payer system, everyone would have federal health insurance, and it would be difficult for providers to deny patients on the federal plan without going out of business. "The reality is that people on Medicaid would see a substantial increase in the quality of care under Sen. Sanders' Medicare-for-all plan," he wrote.</p>
<p><img style="float:right;" src="http://static2.businessinsider.com/image/568edbdac08a80ae2f8b6d93-664-498/us-says-113-million-americans-have-signed-up-for-2016-obamacare-plans.jpg" alt="Kay Campos, 56, who has no health insurance and diabetes, browses leaflets at a Covered California event which marks the opening of the state's Affordable Healthcare Act, commonly known as Obamacare, health insurance marketplace in Los Angeles, California, October 1, 2013. REUTERS/Lucy Nicholson" data-mce-source="Thomson Reuters" data-mce-caption="Campos, who has no health insurance and diabetes, browses leaflets at a Covered California event in Los Angeles" />Any improvements in access would come at a cost for those households, Thorpe noted. "In terms of the financial piece of it, they would be the losers," he said.</p>
<p>The effect on Medicaid beneficiaries who do not work would be limited, since they do not have employers who would be paying more in taxes. And there are some groups of Americans living in poverty, or close to it, whom the plan would arguably help.</p>
<p>The nonpartisan Kaiser Family Foundation has estimated that 2.9 million poor adults are ineligible for Medicaid because they live in states that did not expand the program. They are also ineligible for the federal subsidies that families living above the poverty level apply toward insurance under the Affordable Care Act. The law was drafted on the assumption that states would expand Medicaid, and it did not extend those subsidies to people who would be eligible for the expanded program. Under Sanders' plan, those people would have a chance to enroll in governmental health insurance.</p>
<p>Another 8.8 million people are already eligible for Medicaid but haven't signed up. Sanders' plan, in which all Americans are eligible, would presumably simplify the process, possibly encouraging some of these people to subscribe. If they work, though, they'd most likely be better off financially signing up for Medicaid under the current system than if they enrolled under Sanders' plan.</p>
<p>Finally, there are those households whose income makes them ineligible for Medicaid but for whom health insurance is a serious financial burden. In states that have expanded Medicaid, for example, a family of three is ineligible if their annual income exceeds about $28,000. Nonetheless, paying premiums and deductibles is difficult because of their modest incomes.</p>
<p><img style="float:right;" src="http://static6.businessinsider.com/image/56cdbcf12e5265ba008b925f-4539-3405/rtx282ru.jpg" alt="barack obama" data-mce-source="REUTERS/Carlos Barria" data-mce-caption="President Barack Obama." />Some might use subsidies made available by Obama's Affordable Care Act to help pay monthly premiums, but they must pay exorbitant deductibles and coinsurance out of pocket if they need to see a doctor. Others, despite being eligible for a subsidy or even working for an employer who sponsors a plan, choose not to enroll.</p>
<p>"Even if there's a subsidy, their family resources are still stretched, and they really are having trouble figuring out how to afford the coverage," said Diane Rowland, an executive vice president at Kaiser. "How you get it, and what your share of the cost is, is going to be a big factor in whether you feel you can afford it or not."</p>
<p>Sanders has been making his case to these Americans in the lower-middle class by talking about the onerous out-of-pocket medical costs that even families with insurance often must pay. He makes the case that his plan would save them money. Sanders' opponents say those savings are illusory and the senator is underestimating the amount those families would have to pay in increased taxes to fund his system.</p>
<p>In any case, these are the Americans whom Sanders' proposal has a chance of helping &mdash; those who aren't impoverished but who still can't afford the coverage offered by their employers or through the federal exchanges.</p>
<!-- Newscred Content Analytics: 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 --><p><a href="http://www.businessinsider.com/bernie-sanders-health-plan-might-be-bad-for-the-poor-2016-2#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/dermatologist-best-way-wash-your-face-2016-11">The 3 worst things you do when you wash your face — according to a dermatologist</a></p> http://www.businessinsider.com/cruzs-tax-plan-would-massively-cut-taxes-but-only-for-the-top-1-2016-2Cruz's tax plan would massively cut taxes — but only for the top 1%http://www.businessinsider.com/cruzs-tax-plan-would-massively-cut-taxes-but-only-for-the-top-1-2016-2
Tue, 16 Feb 2016 19:19:00 -0500Rob Garver
<p><img style="float:right;" src="http://static5.businessinsider.com/image/56b019a058c32378008b70b4-4196-3147/rtx24zmt.jpg" alt="ted cruz" data-mce-source="REUTERS/Jim Young" data-mce-caption="Sen. Ted Cruz (R-Texas)." /></p><p>An analysis of Sen. Ted Cruz&rsquo;s tax reform proposal finds that the plan would slash federal revenues so deeply that even if the entire Defense Department budget were eliminated, it would still increase the federal deficit and debt.</p>
<p>The Republican presidential contender&rsquo;s plan would also deliver the top 0.1 percent of earners in the U.S. average annual tax savings of about $2 million. Meanwhile, the bottom 20 percent of earners would net $46, even as the plan put downward pressure on wages, according to the detailed analysis of the plan conducted by the non-partisan Tax Policy Center, a joint project of the Brookings Institution and the Urban Institute.</p>
<p><a href="http://www.thefiscaltimes.com/Columns/2016/02/16/GOP-s-Blind-Spot-Defense-Spending-Will-Explode-Debt"></a>TPC director Len Burman called the plan &ldquo;very regressive,&rdquo; but noted that it does have positive elements. It would vastly simplify tax filing for the majority of taxpayers by removing almost all deductions and collapsing the personal income tax rate structure to a single 10 percent bracket. It would also effectively make all savings tax exempt, reduce many of the tax-related distortions in how capital is allocated across the economy and would generally increase incentive to work, save and invest.</p>
<p>The plan would also&nbsp;eliminate payroll taxes, estate and gift taxes and the corporate income tax.&nbsp;</p>
<p>&ldquo;The giant caveat is that unless the reduction in revenue were offset by spending cuts, increased government borrowing would push up interest rates and crowd out private investment, negating some or all of the plan&rsquo;s positive incentive effects,&rdquo; said Burman in a conference call with reporters.</p>
<p>The TPC analysis estimates that the Cruz plan would result in a net decrease in federal revenues of $8.6 trillion over the first 10 years, and an additional $12.2 trillion over the over the following decade, not including the effect of increased interest rates on government borrowing and possible macroeconomic effects.</p>
<p>&ldquo;The Cruz plan would require unprecedented spending cuts to avoid adding to the federal debt,&rdquo; the report concluded. &ldquo;We estimate that the plan would reduce revenues by $935 billion in 2025 (before considering macroeconomic effects).&rdquo;</p>
<p><a href="http://www.thefiscaltimes.com/2016/02/11/Rubios-Tax-Plan-Would-Be-Budget-Buster"></a>The report goes on to note that, given Congressional Budget Office estimates of federal spending over the next decade, &ldquo;Congress would need to cut projected program spending by nearly 18 percent to prevent the plan from adding to the deficit in 2025. If Congress eliminated all defense spending (about $711 billion), it could not meet this goal. It would need to cut discretionary spending by 67 percent, or about 34 percent of all Medicare and Social Security spending, to offset the direct revenue loss.&rdquo;</p>
<p><img class="center" src="http://static6.businessinsider.com/image/56b6a2e26e97c627008b5751-3500-2258/rtx25six.jpg" alt="ted cruz donald trump" data-mce-source="REUTERS/Carlo Allegri" data-mce-caption="Ted Cruz, left, and Donald Trump." />A centerpiece of the Cruz plan is replacing the federal corporate income tax with what his campaign calls a &ldquo;business flat tax,&rdquo; which many economists recognize as a Value Added Tax. According to TPC, the tax would be &ldquo;based on the difference between a firm&rsquo;s sales and its purchases from other businesses, which is equal to the value-added of the business.&rdquo;</p>
<p>The VAT would be much simpler than the current system. It would have multiple side effects, though &mdash; not least of which is that, by making labor costs non-deductible as a business expense, it would drive down wages. Also, by moving to a consumption-based system and eliminating taxes on almost all savings and investment, the plan has a built-in benefit for the wealthy, who typically save more and spend less of their income on a percentage basis than lower-income individuals.</p>
<p><span>&ldquo;On average, households at all income levels would receive tax cuts,&rdquo; TPC found, &ldquo;but the highest-income households would receive the largest cuts, both in dollars and as a percentage of income.</span></p>
<p>&ldquo;The highest-income 1.0 percent would get an average tax cut of over $400,000 (26 percent of after-tax income), and the top 0.1 percent would get an average tax cut worth nearly $2 million, 29 percent of after-tax income. By contrast, the lowest-income households would receive an average tax cut of $46, or 0.4 percent of after-tax income. Middle-income households would receive an average tax cut of nearly $1,800, or about 3 percent of after-tax income.&rdquo;</p>
<p>Cruz has presented his plan as a revolutionary change that would spark an economic boom while benefiting all Americans, regardless of income level.</p>
<p><img class="center" src="http://static4.businessinsider.com/image/56b370c18fe4de3d5f259f2f-1731-1298/ted-cruz-180.jpg" alt="ted cruz" data-mce-source="reuters" />&ldquo;Imagine 4.9 million new jobs,&rdquo; he has said. &ldquo;Instead of Obama&rsquo;s income stagnation, imagine average wages rising 12.2 percent over the next decade. Capital investment rising 43.9 percent. And every income-level seeing double-digit increases in after-tax income. Imagine exports and manufacturing jobs booming. Our trade deficit falling as the tax bias against American-made goods is eliminated. Imagine a 10 percent income tax, with every American filling out his or her taxes on a postcard or iPhone app. And abolishing the IRS as we know it.&rdquo;</p>
<p><a href="http://www.thefiscaltimes.com/2016/02/10/Hacked-Again-Can-IRS-Protect-Your-Tax-Info-Year"></a>But the bottom line, according to the TPC&rsquo;s analysis, is much grimmer.</p>
<p>&ldquo;[T]he proposal would significantly change the distribution of federal tax burdens by reducing taxes dramatically for households at the very top of the income distribution and by providing little change or even higher taxes for households at the bottom of the distribution,&rdquo; the report found. &ldquo;In addition, barring extraordinarily large cuts in government spending or future tax increases, it would yield persistently large, and likely unsustainable, budget deficits.&rdquo;</p>
<p>Rather than lead to economic boom times, said TPC director Burman, Cruz&rsquo;s plan would have the exact opposite effect.</p>
<p>&ldquo;The plan by itself, not considering the unspecified spending cuts, would almost surely depress the economy over the long run,&rdquo; he said.</p><p><a href="http://www.businessinsider.com/cruzs-tax-plan-would-massively-cut-taxes-but-only-for-the-top-1-2016-2#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/insectothopter-cia-dragonfly-spy-drone-military-defense-espionage-spies-2016-12">In the 1970s the CIA created a spy drone the size of a dragonfly</a></p> http://www.businessinsider.com/states-ration-hepatitis-c-drug-treatment-2016-2States are trying to save money by rationing a crucial drug treatmenthttp://www.businessinsider.com/states-ration-hepatitis-c-drug-treatment-2016-2
Thu, 11 Feb 2016 21:02:00 -0500Eric Pianin
<p><img style="float:right;" src="http://static2.businessinsider.com/image/56002711bd86ef18008bbdb3-2816-2112/6127242068_5a850581e0_o.jpg" alt="pills money" data-mce-source="Flickr/Images Money" /></p><p>Under the staggering cost of providing a state of the art drug to combat the deadly Hepatitis-C virus, as many as three fifths of state Medicaid programs have imposed tough restrictions on millions of low income patients and veterans seeking reimbursement for the treatment, which can cost as much as $100,000 for a single course of treatment.</p>
<p>Thirty-three states spent more than $1 billion a year to treat the disease with Sovaldi, according to <a href="http://www.grassley.senate.gov/news/news-releases/data-behind-sovaldi-report-wyden-grassley-investigation-looks-drug-costs-every">data released</a> last December by Sens. Charles Grassley (R-IA), and Ron Wyden (D-OR). Remarkably, even at that high level, that money could only treat 2.4 percent of Medicaid patients who were infected with the Hep-C virus.</p>
<p><a href="http://www.thefiscaltimes.com/2015/06/30/Medicaid-Denying-Life-Saving-Cure-Based-Cost"></a>Although state officials bridle at this being described as pricey drug rationing, many states restrict the use of Sovaldi and Harvoni, the two most effective drugs for treating the disease, to patients with the most advanced cases of liver disease or who can provide certification from gastroenterology or liver transplant specialists that they need the treatment immediately. Medicaid bureaucrats deny the drug to people who continue to abuse drugs or alcohol or who are deemed to have little chance of benefiting from the treatment.</p>
<p>States are saving hundreds of millions of dollars annually by enforcing these drug rationing procedures and say they would bust their budgets if they had to pay for &lsquo;wonder drugs&rsquo; to treat every Hep-C patient who applies for prescription drug coverage. Gilead Sciences, which manufacturers both biologic medications, touts cure rates of as high as 95 percent in contrast to 40 percent for less advanced treatments. But Sovaldi and Harvoni can cost between $83,000 and $95,000 retail for a full course of treatment.</p>
<p>Matt Salo, executive director of the National Association of State Medicaid Directors, told Pew Charitable Trust&rsquo;s <a href="http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/02/09/are-states-obligated-to-provide-expensive-hepatitis-c-drugs">Stateline</a> publication this week that having to make those drugs available to all those infected with hepatitis C &ldquo;would blow up state budgets.&rdquo;</p>
<p>&ldquo;We would be spending more on this one drug than all other drugs combined,&rdquo; Salo said. &ldquo;There isn&rsquo;t the capacity to do that.&rdquo;</p>
<p><a href="http://www.thefiscaltimes.com/2015/06/25/Wonder-Drugs-Blow-1-Billion-Hole-VA-s-Budget"></a>But consumer and civil rights advocates who view rationing by Medicaid, Medicare, the Department of Veterans Affairs and other government agencies and programs as a matter of life or death are pushing back by seeking redress in the federal courts.</p>
<p><img class="center" src="http://static1.businessinsider.com/image/55ff647cbd86ef1f008bbab8-853-640/pills.jpg" alt="pills" data-mce-source="Enny Nuraheni / Reuters" data-mce-caption="Most pills today are made in factories like this one in Indonesia." />Stateline says these groups have filed class action suits in Indiana, Massachusetts, Minnesota and Pennsylvania, arguing that state Medicaid programs are obliged by law to cover the medication of any low-income person seeking the medical treatment. That&rsquo;s because, under federal statute, states can only exclude a drug from its formulary if it is not prescribed for &ldquo;a medically accepted indication&rdquo; as determined by the Federal Drug Administration.</p>
<p>"If something is medically necessary, it's medically necessary and must be covered by the Medicaid program," said Gavin Rose, an attorney for the American Civil Liberties Union in Indiana, according to <a href="http://www.npr.org/sections/health-shots/2015/12/27/460086615/states-deny-pricey-hepatitis-c-drugs-to-most-medicaid-patients">National Public Radio</a>. He is representing Sarah Jackson, a former drug abuser who discovered she had hepatitis but couldn&rsquo;t persuade Medicaid to cover the cost of a Harvoni treatment.</p>
<p>There are many legitimate reasons for the state and federal government to be parsimonious in funding new biologic drugs &ndash; including the possibility that some patients make poor candidates for treatment. Some doctors argue that while new Hep-C drugs can slow down or arrest the spread of the virus, they can&rsquo;t reverse or undo the damage done to the liver.</p>
<p>Still, creating long waiting lists can be dangerous, as the VA found out the hard way last year following the revelation that scores of veterans had died waiting to see a doctor.</p>
<p>Indeed, if they are put off for too long, &ldquo;patients with less advanced Hep-C may develop cirrhosis, liver cancer or liver failure, which may necessitate a liver transplant,&rdquo; according to Stateline. U.S. Centers for Disease Control and Prevention data show that 60 to 70 percent of those with Hep-C will develop chronic liver disease; that one in five will develop cirrhosis and another 20 percent will die of liver failure or liver cancer.</p>
<p>While there&rsquo;s no way of telling how the court cases will go, one thing going for the plaintiffs is that the federal courts already have set a lower standard for health care in federal prisons, where officials can deliver the drug as they see fit, as long as they don&rsquo;t demonstrate a &ldquo;deliberate indifference to serious medical need.&rdquo;</p><p><a href="http://www.businessinsider.com/states-ration-hepatitis-c-drug-treatment-2016-2#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/trailer-martin-scorsese-film-silence-paramount-andrew-garfield-liam-neeson-adam-driver-2016-11">Watch the trailer for the new Martin Scorsese film that took over 20 years to make</a></p> http://www.businessinsider.com/obamacare-didnt-cause-employment-disaster-2016-1A new study suggests the biggest worry about Obamacare never materializedhttp://www.businessinsider.com/obamacare-didnt-cause-employment-disaster-2016-1
Sun, 10 Jan 2016 06:00:00 -0500Bob Bryan
<p><img style="float:right;" src="http://static1.businessinsider.com/image/568acf82c08a80ae2f8b5af8-2728-2046/gettyimages-147343848.jpg" alt="obamacare protest" data-mce-source="Alex Wong/Getty Images" data-mce-caption="Anti-Obamacare protesters wear masks of U.S. President Barack Obama and Grim Reaper as they demonstrate in front of the U.S. Supreme Court June 28, 2012 in Washington, DC." /></p><p>Around the time of the passing of the Affordable Care Act, known as Obamacare, many opponents of the law argued that it would change the way Americans worked for the worse.</p>
<p><a href="https://www.nber.org/papers/w21836">A new study</a> suggests, however, that this doom-and-gloom scenario has not come to pass.</p>
<p>Robert Kaestner, Anuj Gangopadhyaya, and Caitlyn Fleming from the University of Illinois and Bowen Garrett of the Health Policy Center <a href="https://www.nber.org/papers/w21836">examined the effects on the labor market</a> of a Medicaid expansion that was introduced as part of the ACA.</p>
<p>According <a href="https://www.nber.org/papers/w21836">to the study</a>, there was fear that <a href="http://journal.ijreview.com/2015/12/250991-cbo-admitting-sad-reality-obamacare-democrats-refuse-acknowledge/">to qualify</a> for Medicaid, <a href="http://cnsnews.com/news/article/susan-jones/cbo-obamacare-will-reduce-incentives-work-wh-spins-it-choice">workers may</a> <a href="http://money.cnn.com/2014/02/04/news/economy/obamacare-work/">decrease work effort</a> <a href="http://thehill.com/policy/healthcare/262360-cbo-projects-2-million-fewer-jobs-under-obamacare">by cutting back hours</a>.&nbsp;<span>By reducing hours, such workers would receive wages low enough to qualify for Medicaid.</span></p>
<p>That change, the researchers said, has not materialized.</p>
<p>"Estimates of the effect of Medicaid on labor supply were, in general, relatively small and not statistically significant," the study said. "In fact, most estimates of the effect of the Medicaid expansions on labor supply were positive. Overall, there was very little evidence that the Medicaid expansions decreased work effort."</p>
<p>The researchers analyzed data from 22 states that expanded or initiated Medicaid coverage at the beginning of 2014. Additionally, they zeroed in on people with a high-school diploma or less, as they are most likely to earn around the Medicaid cutoff line.</p>
<p>The researchers looked at changes for three indicators: employment, number of hours worked versus the previous year, and whether the person worked 30 hours or more a week.</p>
<p>"To summarize, we find that the 2014 Medicaid expansions did not have substantial effects on the labor supply of low-educated persons in the US," the study said.</p>
<p>For instance, the researchers found that&nbsp;for&nbsp;childless adults the combined change in the three indicators that could be attributed to the Medicaid expansion was just -0.003% to 0.003%. Most of the other samples were similarly tiny.</p>
<p>"The bottom line is that we can rule out large negative effects of Medicaid on labor supply such as those in Garthwaite et al. and in the upper range of estimates from the Wisconsin study," the researchers said. "Moreover, most of our point estimates are positive suggesting that, if anything, Medicaid increased labor supply."</p>
<p>While there are certainly other concerns about the impact of the ACA on workers, the study suggests the idea that the law will<span>&nbsp;</span>"<a href="http://www.bloombergview.com/articles/2014-05-15/best-argument-yet-against-medicaid-expansion">keep&nbsp;<span>many beneficiaries in poverty</span></a><span>"</span>&nbsp;is simply not panning out.<span></span></p><p><strong>SEE ALSO:&nbsp;<a href="http://www.businessinsider.com/why-southerners-die-of-heart-disease-2015-12" >There's an economic explanation for why so many more Southerners die of heart disease</a></strong></p>
<p><a href="http://www.businessinsider.com/obamacare-didnt-cause-employment-disaster-2016-1#comments">Join the conversation about this story &#187;</a></p> <p>NOW WATCH: <a href="http://www.businessinsider.com/president-obama-executive-order-nra-gun-show-loophole-trump-2016-1">President Obama plans to use an executive order to narrow a gun show loophole</a></p>